Abstract:Objective To investigate the infection status and changing trend of hepatitis C virus (HCV) infection in hospitalized patients in medical institutions, and provide reference for formulating HCV infection prevention and control strategies. Methods HCV infection surveillance results from cross-sectional survey data reported to China Healthcare-associated Infection (HAI) Surveillance System in 2020 were summarized and analyzed, HCV positive was serum anti-HCV positive or HCV RNA positive, survey result was compared with the survey results from 2003. Results In 2020, 1 071 368 inpatients in 1 573 hospitals were surveyed, 738 535 of whom underwent HCV test, 4 014 patients were infected with HCV, with a detection rate of 68.93% and a HCV positive rate of 0.54%. The positive rate of HCV in male and female patients were 0.60% and 0.48%, respectively, with a statistically significant difference(χ²=47.18, P < 0.001). The HCV positive rate in the 50- < 60 age group was the highest (0.76%), followed by the 40- < 50 age group (0.71%). Difference among all age groups was statistically significant (χ²=696.74, P < 0.001). In 2003, 91 113 inpatients were surveyed, 35 145 of whom underwent HCV test, resulting in a detection rate of 38.57%; 775 patients were infected with HCV, with a positive rate of 2.21%. In 2020, HCV positive rates in hospitals of different scales were 0.46%-0.63%, with the highest in hospital with bed numbers ranging 600-899. Patients' HCV positive rates in hospitals of different scales was statistically significant (χ²=35.34, P < 0.001). In 2020, 12 provinces/municipalities had over 10 000 patients underwent HCV-rela-ted test, and HCV positive rates ranged 0.19%-0.81%, with the highest rate from Hainan Province. HCV positive rates in different departments were 0.06%-0.82%, with the lowest positive rate in the department of pedia-trics and the highest in the department of internal medicine. In 2003 and 2020, HCV positive rates in the department of infectious diseases were the highest, being 7.95% and 3.48%, respectively. Followed by departments of orthopedics (7.72%), gastroenterology (3.77%), nephrology (3.57%) and general intensive care unit (ICU, 3.10%) in 2003, as well as departments of gastroenterology (1.35%), nephrology (1.18%), endocrinology (0.91%), and general intensive care unit (ICU, 0.79%) in 2020. Conclusion Compared with 2003, HCV positive rate decreased significantly in 2020. HCV infected patients were mainly from the department of infectious diseases, followed by departments of gastroenterology, nephrology and general ICU. HCV infection positive rate varies with gender, age, and region.

Abstract:Objective To explore the value of droplet digital polymerase chain reaction (ddPCR) in the etiological diagnosis of severe acute pancreatitis (SAP) patients with suspected bloodstream infection (BSI). Methods SAP patients admitted to the department of critical care medicine in a hospital July to September 2022 were enrolled. When BSI was suspected, venous blood was collected for both ddPCR detection and blood culture (BC) with antimicrobial susceptibility testing (AST) simultaneously. The time required for two detection methods was recorded, and the detection results of ddPCR and BC were compared. The etiological diagnostic efficacy of ddPCR was calculated, and the correlation between the value of pathogen load detected by ddPCR and the level of infection parameters was explored. Results A total of 22 patients were included in the analysis, and 52 venous blood specimens were collec-ted for detection. BC revealed 17 positive specimens (32.7%) and 29 pathogenic strains, while ddPCR showed 41 positive specimens (78.8%) and 73 pathogenic strains. Detection time required for ddPCR was significantly lower than that of BC ([0.16±0.03] days vs [5.92±1.20] days, P<0.001). Within the detection range of ddPCR and taking BC results as the gold standard, the sensitivity and specificity of ddPCR were 80.0% and 28.6%, respectively. With the combined assessment of BSI based on non-blood specimen microbial evidence within a week, the sensitivity and specificity of ddPCR detection increased to 91.9% and 76.9%, respectively. ddPCR detected resistance genes of bla_KPC, bla_NDM/IMP, VanA/VanM, and mecA from 19, 9, 6, and 5 specimens, respectively. Correlation analysis showed a positive correlation between pathogen load and levels of C-reactive protein as well as procalcitonin (r=0.347, 0.414, P<0.05). Conclusion As a supplementary detection method for BC in BSI diagnosis, ddPCR has the advantages of higher sensitivity and shorter detection time, and is worthy of further exploration in clinical application.

Abstract:Objective To compare the differences in virulence-related factor aspartate protease, biofilm formation, and gene expression among clinical isolates of Candida parapsilosis (C. parapsilosis). Methods Gene sequencing and microsatellite typing (MT) method were adopted to identify C. parapsilosis isolated from patients with clinical fungal infection. The production of secreted aspartate protease and biofilm formation ability of each strain were detected, and the expression of biofilm formation related-genes BCR1, EFG1, and HWP1, as well as aspartate protease virulence genes SAPP1, SAPP2, SAPP3 were compared among the strains. Results A total of 8 clinically isolated C. parapsilosis strains were collected, all of which were identified as genotype Ⅰ. Based on microsatellite typing results, 8 clinical strains were divided into 4 microsatellite types. G1, G2, and G3 strains isolated from the urine, peripherally inserted central catheters (PICC), and blood of patient A were of different subtypes. J1, J2, J3, J4, and J5 strains were of the same type, and isolated from blood specimens of patient B at different periods. All 8 clinical strains could form biofilm, and their biofilm formation ability was higher than that of the standard strain of C. parapsilosis (ATCC 22019). G1, G3 and J5 strains had strong biofilm formation ability, J1, J2, J3, and J4 strains had moderate biofilm formation ability, and G2 strain had weak biofilm formation ability. All of the eight clinical isolates secreted aspartate protease, and their in vitro expression levels of the enzyme were higher than that of the standard strain (ATCC 22019). G3, G1, and G2 strains showed low, moderate, and high in vitro enzyme expression respectively, with statistical differences (all P<0.05). Enzyme expressed moderately in J1 and J5 strains, and highly in J2, J3, and J4 strains. Difference between moderate and high expressions was statistically significant (P<0.05). The expression levels of biofilm formation genes BCR1, EFG1, and HWP1 in various strains isolated from patients A and B increased. In strains isolated from patient A, the expression level of EFG1 gene in G1 strain was higher than that in G2 strain (P<0.05). There was no statistically significant difference in BCR1, EFG1, and HWP1 gene expression levels among strains isolated from patient B. The expression levels of aspartate protein genes (SAPP1, SAPP2, and SAPP3) in various strains isolated from patients A and B increased. The expression levels of SAPP1 and SAPP2 in strain G1 were higher than those in G2 and G3 (both P<0.05). There was no statistically significant difference in the expression levels of SAPP1, SAPP2, and SAPP3 genes in strains from patient B. Conclusion Clinical isolates of C. parapsilosis have higher biofilm formation and aspartate protease production abilities than standard strain. The expression of virulence factors varies among strains isolated from different specimens, while there is no significant difference in the expression of virulence factors among strains isolated at different periods. Patients may have been infected with different MT types of C. parapsilosis in multiple sites during the same period.

Abstract:Objective To understand the respiratory protection competency of staff in hospitals. Methods Staff from six hospitals of different levels and characteristics in Beijing were selected, including doctors, nurses, medical technicians, and servicers, to conduct knowledge assessment on respiratory protection competency. According to exposure risks of respiratory infectious diseases, based on actual cases and daily work scenarios, content of respiratory protection competency assessment was designed from three aspects: identification of respiratory infectious diseases, transmission routes and corresponding protection requirements, as well as correct selection and use of masks. The assessment included 6, 6, and 8 knowledge points respectively, with 20 knowledge points in total, all of which were choice questions. For multiple-choice questions, full marks, partial marks, and no mark were given respectively if all options were correct, partial options were correct and without incorrect options, and partial options were correct but with incorrect options. Difficulty and discrimination analyses on question of each knowledge point was conducted based on classical test theory. Results The respiratory protection competency knowledge assessment for 326 staff members at different risk levels in 6 hospitals showed that concerning the 20 knowledge points, more than 60% participants got full marks for 6 points, while the proportion of full marks for other questions was relatively low. Less than 10% participants got full marks for the following 5 knowledge points: types of airborne diseases, types of droplet-borne diseases, conventional measures for the prevention and control of healthcare-associated infection with respiratory infectious diseases, indications for wearing respirators, and indications for wearing medical protective masks. Among the 20 knowledge questions, 5, 1, and 14 questions were relatively easy, medium, and difficult, respectively; 6, 1, 4, and 9 questions were with discrimination levels of ≥0.4, 0.30-0.39, 0.20-0.29, and ≤0.19, respectively. Conclusion There is still much room for hospital staff to improve their respiratory protection competency, especially in the recognition of diseases with different transmission routes and the indications for wearing different types of masks.

Abstract:Objective To evaluate the efficacy of vitamin C intravenous injection in the treatment of patients with sepsis. Methods PubMed, Embase, Scopus, Cochrane Library, and Clinical Trial databases were retrieved, with a retrieval period from database establishment to December 2022. English literatures on randomized controlled trial (RCT) of vitamin C intravenous injection for the treatment of sepsis or septic shock were collected. Meta-analysis was conducted using RevMan 5.3 software and Stata 15.0 software after literature screening, extraction, and evalua- tion of the bias risk included in the studies by two researchers independently. Results A total of 16 RCT studies involving 3 301 patients were included in the analysis. In terms of main outcomes, the 28-day mortality of patients in the vitamin C treatment group was slightly lower than that of the control group, but the difference was not statistically significant (RR=0.86, 95%CI [0.72-1.03], P=0.10; I²=44%, P=0.10). In terms of secondary outcomes, vitamin C intravenous injection can reduce the duration of vasoactive drug usage time (MD=-23.44, 95%CI [-30.53--16.35], P < 0.01; I²=0, P=0.97), but has no significant effect on the 90-day mortality, intensive care unit mortality, hospital mortality, duration of mechanical ventilation, difference in estimated sequential organ failure assessment score at 72 hour, length of stay in ICU, and total length of hospital stay of patients (P > 0.05). Conclusion Intravenous vitamin C injection can significantly reduce vasoactive drug usage time, but the available evidence is insufficient to support that intravenous vitamin C can improve the prognosis of patients with sepsis or septic shock. More high-quality, multicenter randomized controlled trial is needed to provide more substantial evidence about the efficacy of vitamin C in treating sepsis or septic shock.

Abstract:Objective To investigate the attributable risk (AR) of Acinetobacter baumannii (AB) infection in criti- cally ill patients. Methods A multicenter retrospective cohort study was conducted among adult patients in intensive care unit (ICU). Patients with AB isolated from sterile body fluid and confirmed with AB infection in each center were selected as the infected group. According to the matching criteria that patients should be from the same period, in the same ICU, as well as with similar APACHE Ⅱ score (±5 points) and primary diagnosis, patients who did not infect with AB were selected as the non-infected group in a 1:2 ratio. The AR was calculated. Results The in-hospital mortality of patients with AB infection in sterile body fluid was 33.3%, and that of non-infected group was 23.1%, with no statistically significant difference between the two groups (P=0.069). The AR was 10.2% (95%CI: -2.3%-22.8%). There is no statistically significant difference in mortality between non-infected patients and infected patients from whose blood, cerebrospinal fluid and other specimen sources AB were isolated (P>0.05). After infected with AB, critically ill patients with the major diagnosis of pulmonary infection had the highest AR. There was no statistically significant difference in mortality between patients in the infected and non-infected groups (P>0.05), or between other diagnostic classifications. Conclusion The prognosis of AB infection in critically ill patients is highly overestimated, but active healthcare-associated infection control for AB in the ICU should still be carried out.

Abstract:Objective To explore the antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from blood and the related risk factors for infection in patients. Methods Clinical data of 383 KP-infected patients from whose blood Klebsiella pneumoniae (KP) were isolated during hospitalization period in a hospital from January 2018 to December 2021 were retrospectively analyzed. Patients were divided into CRKP group (n=114) and non-CRKP group (n=269) based on antimicrobial resistance. According to the prognosis, 114 patients in the CRKP group were subdivided into the death group (n=30) and the survival group (n=84). General information, underlying diseases, antimicrobial use, and infection outcomes of two groups of patients were compared, and risk factors for infection and death after infection were analyzed. Results The resistance rates of KP to tigecycline and compound sulfamethoxazole showed upward trends, with statistically significant differences (both P=0.008). The CRKP group had higher resistance rates to amikacin, aztreonam, compound sulfamethoxazole, ciprofloxacin, cefepime, cefoperazone/sulbactam, piperacillin/tazobactam, tigecycline, ceftazidime, tobramycin, and levofloxacin, as well as higher in-hospital mortality than the non-CRKP group, with statistically significant differences (all P < 0.05). Acute pancreatitis prior to infection (OR=16.564, P < 0.001), hypoalbuminemia (OR=8.588, P < 0.001), stay in intensive care unit prior to infection (OR=2.733, P=0.017), blood transfusion (OR=3.968, P=0.001), bronchoscopy (OR=5.194, P=0.014), surgery within 30 days prior to infection (OR=2.603, P=0.010), and treatment with carbapenems (OR=2.663, P=0.011) were independent risk factors for the development of CRKP bloodstream infection (BSI). Cardiac insufficiency before infection (OR=11.094, P=0.001), combined with pulmonary infection (OR=20.801, P=0.010), septic shock (OR=9.783, P=0.002), disturbance of consciousness (OR=11.648, P=0.001), and receiving glucocorticoid treatment (OR=5.333, P=0.018) were independent risk factors for mortality in patients with CRKP BSI. Conclusion The resistance rate of KP from BSI to tigecycline and compound sulfamethoxazole presents upward trend. Underlying diseases, invasive procedures, and carbapenem treatment are closely related to CRKP BSI. Cardiac insufficiency, pulmonary infection, septic shock, disturbance of consciousness, and glucocorticoid treatment can lead to death of patients with CRKP BSI.

Abstract:Objective To understand the infection status of patients with maintenance hemodialysis (MHD) in Guizhou Province, and provide basis for the prevention and control of hemodialysis-related infection. Methods MHD patients in hemodialysis centers of 124 secondary and or higher grade medical institutions in Guizhou Province from July to December 2022 were surveyed. Survey content included the general conditions of patients, hemodialysis-related conditions, infection of pathogens of blood-borne diseases, and other infection-related conditions. Results A total of 15 114 MHD patients were surveyed, with age mainly ranging from 36 to < 60 years old (55.83%). Hemodialysis history ranged mainly from 1 year to < 5 years (59.37%), and the frequency of hemodialysis was mainly 3 times per week (73.91%). Autologous arteriovenous fistula (AVF) was the major vascular access for dialysis, with a total of 12 948 cases (85.77%). The main primary disease was chronic renal failure (99.89%). The infection rates of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum in MHD patients were 5.29%, 0.64%, 0.24%, and 1.70%, respectively. HBV infection rates among MHD patients of different ages, different numbers of dialysis hospitals, and dialysis institutions of different scales showed statistically significant differences (all P < 0.05). HCV infection rates among MHD patients of different ages, with different dialysis times and from institutions of different scales were significantly different (all P < 0.05). TP infection rates among MHD patients of different ages and different numbers of dialysis hospitals were all significantly different (all P < 0.05). Infection rates of HBV and HCV in MHD patients aged from 36 to 60 years old (not included) were relatively higher (6.10% and 0.84%, respectively). Patients with dialysis time ≥10 years had a higher HCV infection rate (1.64%). Infection rates of HCV, HIV, and TP in patients dialyzed in medical institutions with ≥90 dialysis beds were relatively higher (0.74%, 0.28%, and 1.94%, respectively). Medical institutions with < 30 dialysis beds had the highest HBV infection rate (18.64%). There were 9 cases (0.06%) of vascular puncture infection, 12 cases (0.08%) of bloodstream infection, 7 cases (0.05%) of vascular access-related bloodstream infection, and 30 cases (0.20%) of pulmonary infection. Vascular access-related bloodstream infection rate and pulmonary infection rate among MHD patients with different types of vascular access showed statistically significant difference (all P < 0.05). Vascular access-related bloodstream infection rate (0.37%) and pulmonary infection rate (1.10%) of patients with non-cuffed catheters vascular access were higher than those of other types. Conclusion MHD patients in Guizhou Province are mainly middle-aged and young people, with more males than females. The dialysis frequency is mostly 3 times per week, and AVF is the major vascular access. MHD patients are prone to complications such as infections of HBV, HCV, HIV, and TP, as well as bloodstream infection and pulmonary infection.

Abstract:Objective To understand the changing trend of healthcare-associated infection (HAI) monitoring indexes in 50 secondary and higher grade hospitals in a city for 6 consecutive years from 2017 to 2022. Methods Infection monitoring indexes from 50 secondary or higher grade hospitals in the city for 6 consecutive years were collec-ted, and changing trend of HAI monitoring indexes were compared. Results The number of full-time HAI management professionals increased from 91 in 2017 to 165 in 2022. The utilization rate of HAI information system increased from 17.00% in 2017 to 54.00% in 2022. In 6 consecutive years from 2017 to 2022, the incidence of HAI (0.91% vs 0.59%), prevalence rate of HAI (2.36% vs 1.08%), infection rate of class Ⅰ incision surgical site infection (0.33% vs 0.16%) in 50 secondary or higher grade hospitals all showed downward trends, while health care workers' hand hygiene compliance rate showed an upward trend (61.03% vs 85.04%). Incidences of vascular cathe- ter-related bloodstream infection, ventilator-associated pneumonia, and catheter-associated urinary tract infection all showed downward trends. Incidence of HAI, prevalence rate of HAI, health care workers' hand hygiene compliance rate, and incidence of ventilator-associated pneumonia in tertiary hospitals were all higher than those in secon-dary hospitals, while surgical site infection rate of class Ⅰ incision in secondary hospitals was higher than that in tertiary hospitals, with statistically significant differences (all P < 0.001). Conclusion Standardizing the monitoring of HAI, as well as improving the prevention and control system and measures of HAI according to the monitoring results can reduce the incidence of HAI.

Abstract:Objective To investigate the microbial contamination and management of refrigerators in the ward treatment rooms of a tertiary first-class hospital, and provide reference for strengthening the cleaning and disinfection of medical refrigerators in the ward treatment rooms. Methods A total of 40 refrigerators in use from the treatment rooms of different wards in the hospital were randomly selected for microbial sampling, culture, and bacterial identification. Forty nurses were randomly chosen from the corresponding wards for a questionnaire survey on the daily management of refrigerators. Results A total of 223 specimens were collected, with 142 microbial positive specimens and a positive rate of 63.68%. A total of 247 bacterial strains were detected, including 41.30% (n=102) Gram-positive bacteria, 10.93% (n=27) Gram-negative bacteria, and 47.77% (n=118) fungi. Two strains of multidrug-resistant Pseudomonas aeruginosa from the bottom and drainage tank of the same refrigerator from class-Ⅲ environment were detected, with a detection of multidrug-resistant organisms being 0.90% (2/223). The frequency and methods of routine cleaning and disinfection of refrigerators varied among different wards. Conclusion There are deficiencies in the cleaning and disinfection management of refrigerators in ward treatment rooms of medical institutions. More attention should be paid to the cleaning and disinfection of refrigerators in wards. The healthcare-associated infection management departments should strengthen corresponding supervision and management.

Abstract:Objective To explore the correlation between healthcare-associated infection (HAI) and partial indexes in the diagnosis-related groups (DRGs) of patients in thoracic surgery intensive care unit (ICU). Methods DRGs, case mix index (CMI), relative weight (RW), and HAI of patients in thoracic surgery ICU and four subspecialty departments (pulmonary surgery group, esophageal surgery group, mediastinum group [mainly thymic surgery], and trachea group) in a tertiary chest hospital in Shanghai from January to December 2022 were retrospectively analyzed and compared through DRGs index grouping. Results A total of 1 429 patients in the department of thoracic surgery ICU were analyzed, including 59 HAI cases, with a HAI rate of 4.13%. The incidences of HAI in pulmonary surgery group, esophageal surgery group, mediastinum group and trachea group were 3.74% (30/803), 5.84% (25/428), 1.27% (2/157) and 4.88% (2/41), respectively. There was no statistically significant difference in the incidences of HAI among different subspecialty groups (P>0.05). A total of 35 DRGs were involved, with CMI of 2.75, 3.41, 2.35 and 1.25 in pulmonary surgery group, esophageal surgery group, mediastinum group and trachea group, respectively, and RW ranged from 0.53 to 12.62. In the pulmonary surgery group, incidence of HAI in male patients was higher than that in female patients. Higher RW score level was associated with higher incidence of HAI. Differences were all statistically significant (all P < 0.05). Among patients in the esophageal surgery group, the age of HAI group was higher than that of the non-HAI group (P < 0.05). Higher RW score level was associated with higher incidence of HAI (P < 0.05). Among patients in the mediastinum surgery group, the age of patients in the infected group was higher than that in the non-infected group (P < 0.05). Among the 59 HAI cases, 31 were infected with MDROs. Conclusion Focusing on CMI and RW in the DRGs index system, analyzing HAI from the perspectives of disease complexity and overall technical difficulties of medical services can provide reference for the precise management of HAI in the new era.

Abstract:Objective To explore the clinical characteristics and treatment scheme of patients with spinal infection caused by Prevotella intermedia (P. intermedia). Methods Clinical diagnosis and treatment processes of a patient with spinal infection caused by P. intermedia admitted to the spinal surgery department of a hospital were summarized, and relevant literature was retrieved from database for reviewing. Results The patient, a 50 year old male, was admitted to the hospital due to "lumbago pain complicated with pain in double lower extremities for 2 months". The lesion tissue was taken for metagenomic next-generation sequencing (mNGS) detection, which detected P. intermedia, and the patient was diagnosed with P. intermedia spondylitis. After treatments with open lesion clea-rance, tube rinsing + autologous bone transplantation fusion internal fixation, intravenous drip of ceftriaxone sodium and metronidazole, as well as metronidazole rinsing, infection was under control. A total of 16 available papers were retrieved, together with this case, a total of 17 patients were included, with 7 males and 10 females. The main risk factors were diabetes and history of corticosteroid use (35.3%). The most common invasion sites were lumbar vertebra (n=12) and thoracic vertebra (n=6). 13 cases were positive for pathogen culture, 3 cases were positive for molecular detection, and 1 case was positive for staining microscopy. 17 patients received anti-anaerobic bacteria treatment, with 14 cases receiving combined surgical treatment. One case died, with a mortality of 5.9%; 5 cases had partial neurological impairment, with a disability rate of 29.4%. The survival rate of patients who received treatment of anti-anaerobic bacteria combined with surgery was 92.8%, 3 patients only with anti-anaerobic bacteria treatment but without surgery were all cured. Conclusion P. intermedia is an opportunistic pathogeanic bacteria which often causes infection in immunocomprised individuals and is prone to be misdiagnosed. It is recommended to perform mNGS detection to identify the pathogen as early as possible and seize the opportunity for treatment to reduce mortality.

Abstract:Objective To investigate the screening and prevalence of tuberculosis among freshmen in different schools in Baoding City, and provide reference for tuberculosis control in schools. Methods Screening data of tuberculosis and tuberculin test (PPD) of freshmen from 156 schools in different regions of Baoding City from September 2021 to March 2022 were collected. PPD screening results of students from different regions and different school stages were analyzed and compared. Results A total of 68 177 freshmen from 156 schools were investigated for suspected symptoms and close contact history of pulmonary tuberculosis. PPD screening was conducted on 63 939 students. 13 821 students were PPD positive, with a positive rate of 21.62%. 3 083 students were strongly positive, with a strong positive rate of 4.82%. 15 cases of tuberculosis were found, and the reported incidence was 23.46/100 000. PPD positive rate and strong positive rate as well as incidence of tuberculosis in students in different school stages presented statistically significant differences (all P < 0.01). Positive rate and strong positive rate in students in different school stages showed upward trends (all P < 0.01). PPD positive rate and strong positive rate of students from schools in plain and mountainous areas presented statistically significant differences ([22.28% vs 17.89%]; [4.85% vs 3.62%], both P < 0.01). PPD positive rate and strong positive rate between students from boarding junior school and non-boarding junior school were significantly different, respectively ([23.94% vs 21.60%]; [5.07% vs 3.56%], both P < 0.01). Conclusion It is necessary to strengthen tuberculosis screening and health education for freshmen, especially those from boarding schools in plain areas, screening latent Mycobacterium tuberculosis infection as early as possible, take corresponding measures to prevent and control the spread of tuberculosis, and reduce the risk of tuberculosis.

Abstract:Objective To analyze the characteristics and influencing factors of healthcare-associated bloodstream infection (HA-BSI) of carbapenem-resistant Enterobacterales (CRE). Methods Retrospective nested case-control study was adopted. Fifty-six patients with CRE HA-BSI in a tertiary general hospital from January 2020 to December 2022 were selected as the CRE group. With a 1:1 ratio, 56 patients with carbapenem-sensitive Enterobacterales (CSE) BSI during the same period was selected as the CSE group. Distribution of infection strains and departments was analyzed, and the relevant factors for CRE BSI were analyzed by univariate and multivariate logistic regression analyses. Results The distribution of CRE BSI was mainly in intensive care unit (ICU, n=23, 41.07%) and department of hematology (n=17, 30.36%). The main infection strains were Klebsiella pneumoniae (n=32, 57.14%) and Escherichia coli (n=16, 28.57%). Univariate analysis showed that malignant tumor, hospitalization history within 60 days, stay in ICU for >48 hours before infection, mechanical ventilation, indwelling central venous cathe-ter, combined use of at least two kinds of antimicrobial agents, and duration of antimicrobial use ≥10 days were all related to CRE BSI (all P < 0.05). Multivariate logistic regression analysis found that stay in ICU>48 hours before infection and duration of antimicrobial use ≥10 days before infection were independent risk factors for CRE HA-BSI (P < 0.05). Conclusion Clinical departments, especially ICU, should pay attention to the epidemiological history of patients, identify patients with high-risk factors for CRE BSI as early as possible, use antimicrobial agents ratio-nally and standardize invasive procedure, so as to reduce the occurrence of CRE HA-BSI.

Abstract:Objective To evaluate the clinical application value of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in analyzing the homology of Acinetobacter baumannii (AB). Methods After excluding repetitive strains from multiple specimens of the same patient or environment, a total of 46 AB strains isolated from patients' sputum and environmental specimens of neurological intensive care unit (ICU) in a tertiary first-class general hospital from May 2020 to February 2021 were collected. Strains were detected by VITEK-MS mass spectrometer. Cluster analysis was performed by SARAMIS Premium software, and verified by multilocus sequence typing (MLST). Results Cluster analysis and comparison of MALDI-TOF MS and MLST found that among the 46 AB strains, 39 were the type MS-a of MALDI-TOF MS, of which 22 strains were the cluster MT-A of MLST, including ST208 (n=3), ST540 (n=3), ST195 (n=8), ST369 (n=5), ST136 (n=1), ST436 (n=1) and ST1893 (n=1); 16 strains were MT-B, including type ST381(n=4), type ST469 (n=11), and type ST938 (n=1); one strain was cluster MT-C (ST1821); one strain of type MS-b was ST381; two strains of type MS-c were ST369; one strain of type MS-d was ST195; two strains of type MS-e were ST540 and ST369, respectively; one strain of type MS-f was STN1. Conclusion As a homology analysis method, MALDI-TOF MS still has certain limitations such as low consistency with MLST results, low resolution and specificity, thus cannot replace MLST technology.

Abstract:Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection poses a threat to human life and health, resulting in great socio-economic losses. The structural protein spike protein (S protein) of viruses has always been considered to primarily mediate virus invasion into host cells. S protein can act independently of viruses and cause inflammatory reactions on a variety of cells, therefore, understanding the impact of S protein on the respiratory tract can provide a new perspective for the prevention and treatment of COVID -19. This article reviews the advances in the possible mechanisms and clinical manifestations of SARS-CoV-2 structural protein S protein-induced inflammatory response in respiratory epithelial cells, aiming to provide reference for the prevention and treatment of diseases.

Abstract:Catheter-related bloodstream infection (CRBSI) is an important factor leading to death in patients with venous catheterization. Selection of catheter locking solution has become an important part in maintaining venous catheter. Locking solution with different chemical components have different effects on preventing CRBSI. Therefore, selecting a suitable and effective solution for locking is an important method to reduce the occurrence of CRBSI. This paper reviews different types of domestic and foreign locking solutions with single or compound chemical compositions in the prevention of CRBSI, so as to provide theoretical reference for clinical health care workers in the selection and further research in locking solution.

Abstract:Cytomegalovirus (CMV) pneumonia is one of the common complications of hematopoietic stem cell transplantation, and is also a significant cause leading to patient death. Due to the poor prognosis of CMV pneumonia, intervention measures are necessary to prevent CMV reactivation and progress to CMV pneumonia. At present, clinical medication mainly relies on preemptive treatment strategies, and the timing of medication depends on the timeliness of early diagnosis. However, feasible methodology and measures for the early diagnosis of CMV pneumonia in clinical practice are relatively limited. Meanwhile the diagnostic gold standard operation is invasive, causing trauma to a certain degree, and the detection timeliness is poor. This review summarizes the clinical status and advances in the diagnosis and drug prophylactic treatment of CMV pneumonia after hematopoietic stem cell transplantation, and explores possible development directions and trends in the future.