Abstract:Objective To analyze the spatiotemporal distribution of clinically isolated vancomycin-resistant Enterococcus faecium (VR-Efm) in Guangdong Province in recent years, and explore the causes for the increase in VR-Efm detection rate. Methods A retrospective analysis was conducted on the data about the detection, patients' demographic characteristics, as well as departments and specimens distribution of VR-Efm reported to Guangdong Province Antimicrobial Resistance Surveillance System by 38 medical institutions in 4 regions of Guangdong Province (Pearl River Delta, East Guangdong, West Guangdong, and North Guangdong) in 2019-2023. The detection of 5 other antimicrobial-resistant ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) concerned by World Health Organization was analyzed synchronously. Results The detection rate of VR-Efm in Guangdong Province increased from 1.4%(63/4 543) in 2019 to 21.3% (1 351/6 345) in 2023, showing a significant upward trend. In 2023, 44.7% (n=17) medical institutions had a VR-Efm detection rate of >20%; the detection rate of VR-Efm in 4 regions of Guangdong Province has generally increased, with a radiation increase from the Pearl River Delta region to the surrounding areas. The overall ESKAPE increased from 10.1% in 2019 to 10.8% in 2023. Among the other 5 pathogens, the detection rate of carbapenem-resistant Klebsiella pneumoniae increased from 8.0% in 2019 to 15.0% in 2023. The detection rates of carbapenem-resistant Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacter spp. decreased from 61.6%, 34.4%, 21.2%, and 7.9% in 2019 to 58.2%, 31.9%, 21.0%, and 7.6% in 2023, respectively, all showed varying degrees of decline. The detection rate of VR-Efm in intensive care unit (ICU) (12.2%) was higher than that in non-ICU departments such as outpatient and emergency department (9.4%), internal medicine department (9.2%) and surgery department (7.0%) (all P < 0.05). The specimens with higher detection rates of VR-Efm were urine (9.8%) and blood (9.1%), while the detection rates of other specimens ranged from 6.9% to 9.6%. The detection rate of VR-Efm from adolescent patients was lower than that of middle-aged and elderly patients (4.4% vs >9.4%, P < 0.05). Conclusion In the past 5 years, the detection rate of VR-Efm in Guangdong Province has significantly increased, which may be related to the transmission of dominant clone acquired from communities and hospitals. Medical institutions with favorable condition should conduct VR-Efm screening for hospitalized patients, take effective prevention and control measures for patients with VR-Efm, so as to curb the increase in detection rate of VR-Efm in the region.

Abstract:Objective To investigate the clinical characteristics, risk factors, treatment and prognosis of streptococcal bloodstream infection (BSI). Methods Patients with positive Streptococcus blood culture in a tertiary teaching hospital in East China from January 2018 to December 2021 were selected as the research subjects, their clinical medical data were collected, healthcare-associated infection (HAI) and risk factors for prognosis were retrospectively analyzed. Results A total of 151 patients with streptococcal BSI were included in the analysis, with an average age of (55.5±17.9) years old, 45.70% were >60 years old, male patients accounted for 61.59%, and 89.40% of patients had underlying diseases such as solid tumors, heart valve disease, hepatobiliary diseases, and hypertension. The common risk factors for streptococcal BSI included surgery, immunosuppression, and disruption of skin or mucosal integrity(all P < 0.05). HAI accounted for 25.17% (n=38); common underlying diseases included hepatobiliary diseases, solid tumors, hematologic disorders, and hypertension. Patients with HAI had longer hospital stays and higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ scores) compared with patients with community-associated infection (CAI) (all P < 0.05). Among the 151 detected bacterial strains, the susceptibility rates of α-hemolytic Streptococcus (n=112, except Streptococcus pneumoniae) to penicillin, levofloxacin, and ceftriaxone were 71.43%, 80.38%, and 91.07%, respectively. β-hemolytic Streptococcus (n=29) were 100% susceptible to penicillin; Streptococcus pneumoniae had a susceptibility rate of 50.00% to penicillin. The 30-day allcause mortality of 151 patients was 6.62% (n=10), and the attributable mortality was 2.65% (n=4). Binary logistic regression analysis showed that shock (OR=13.690, 95%CI: 1.482-126.470) and Pitt bacteremia score ≥4 (OR=10.461, 95%CI: 1.042-105.005) were independent risk factors for mortality in patients with streptococcal BSI. Conclusion Streptococcal BSI is mainly CAI, and there are multiple risk factors for hospital-associated streptococcal BSI. Shock and Pitt bacteremia scores ≥4 are independent risk factors for death in patients with streptococcal BSI.

Abstract:Objective To understand the change in antimicrobial resistance of Granulicatella adiacens (G. adiacens) clinically isolated from blood specimens in China, provide basis for clinical treatment. Methods Surveillance on antimicrobial resistance of bacteria was carried out according to the requirements of China Antimicrobial Resistance Surveillance System (CARSS). Antimicrobial susceptibility testing results of G. adiacens isolated from blood specimens of member units of CARSS in 2014-2021 were analyzed based on standard of American Clinical and Laboratory Standards Institute (CLSI). Results 83-152 strains of G. adiacens were isolated from blood specimens from member units of CARSS each year from 2014 to 2021, there was a gradual increasing trend after 2017. The susceptibility rates of G. adiacens isolated from blood specimens to vancomycin and meropenem were 100% and 93.7% respectively, to ceftriaxone, cefotaxime and cefepime were about 90%, to levofloxacin, penicillin, erythromycin and clindamycin were 82.8%, 65.0%, 32.7% and 46.8%, respectively. From 2014 to 2021, susceptibility rates of G. adiacens to partial antimicrobial agents increased to varying degrees, but to cefepime and meropenem decreased. Conclusion The number of G. adiacens isolated from blood specimens showed a rising trend, G. adiacens exhibits varying degrees of resistance to penicillin, cephalosporins, carbapenems, fluoroquinolones and macrolides, but no vancomycin-resistant strain was found.

Abstract:Objective To investigate the change in antimicrobial resistance of all Klebsiella spp. and Klebsiella spp. isolated from pediatric patients in Hunan Province, provide evidence for rational use of antimicrobial agents in the medical institutions in this area. Methods Data about Klebsiella spp. from Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021 were analyzed, and the results were judged according to M100 32nd edition standard of American Clinical and Laboratory Standards Institute (CLSI), WHONET 5.6 software was used to statistically analyze the results. Results A total of 361 539 Klebsiella spp. strains were isolated from hospitals in Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021, Klebsiella pneumoniae accounted for 86.7%, and strains were mainly from respiratory tract specimens (66.5%). The resistance rate of Klebsiella spp. to imipenem and meropenem were about 10.0% in 2015-2021. The resistance rate to tigecycline decreased, with a resistance rate of 7.1% in 2012-2013 and an annual average resistance rate < 4.0% in 2018-2021. The resistance rate of bacteria to cefoperazone/sulbactam increased significantly in 2012-2021, with a rate of 13.3% in 2020-2021. Carbapenems resistance rates of Klebsiella spp. from pediatric patients in 2015-2021 were 3.5%-8.6%, and the resistance rates to tigecycline were all ≤3.8% in 2012-2021. The detection rates of carbapenem-resistant Klebsiella spp. in newborns, children aged 29 days-14 years, adults and elderly patients in 2020-2021 were 4.7%, 3.9%, 9.5% and 10.2%, respectively. Conclusion The resistance rates of Klebsiella spp. to carbapenems were low in 2012-2021, tigecycline-resistant strains have emerged, which should be paid attention to, antimicrobial agents should be used rationally to prevent and control the occurrence of healthcare-associated infection.

Abstract:Objective To investigate the distribution and antimicrobial resistance change of respiratory bacteria isolates from Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021. Methods Bacterial identification and antimicrobial susceptibility testing were performed according to technical scheme of China Antimicrobial Resistance Surveillance System (CARSS), duplicate strains were eliminated. Antimicrobial susceptibility was judged according to the standards from American Clinical and Laboratory Standards Institute (CLSI) 2022, statistical analysis was conducted with WHONET 5.6 software. Results A total of 976 984 bacteria strains isolated from respiratory specimens were collected in Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021. 185 642 strains (19.0%) were Gram-positive and 791 342 (81.0%) were Gram-negative bacteria. The top 5 bacteria isolated from respiratory specimens of adult patients were Klebsiella pneumoniae (25.2%), Pseudomonas aeruginosa (17.0%), Acinetobacter baumannii (14.6%), Escherichia coli (6.7%) and Staphylococcus aureus (5.8%). The top 5 bacteria isolated from respiratory specimens of pediatric patients were Staphylococcus aureus (17.7%), Streptococcus pneumoniae (15.6%), Escherichia coli (13.5%), Klebsiella pneumoniae (13.1%) and Haemophilus influenzae (10.8%). Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae showed lower resistance rates to tigecycline, cefoperazone/sulbactam, piperacillin/tazobactam, carbapenem and amikacin (< 15%). The resistance rates of Klebsiella pneumoniae to imipenem and meropenem increased from 3.5% and 4.2% in 2012-2013 to 9.5% and 11.5% in 2020-2021, respectively, resistance rates to cefoperazone/sulbactam, piperacillin/tazobactam, amikacin, tobramycin, ciprofloxacin and levofloxacin showed an upward trend. Resistance rates of Escherichia coli and Enterobacter cloacae to aztreonam, aminoglycosides, and fluoroquinolones showed a downward trend. Resistance rate of Pseudomonas aeruginosa to polymyxin and resistance rates of Acinetobacter baumannii to tigecycline and polymyxin were all lower (all < 6%). Resistance rates of Pseudomonas aeruginosa to β-lactams, aminoglycosides and fluoroquinolones decreased. Resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam increased from 18.0% to 43.7%, to piperacillin/tazobactam, imipenem, fluoroquinolones and minocycline showed an upward trend. No Staphylococcus aureus strain was found to be resistant to vancomycin, teicolanin and linezolid. Isolation rates of methicillin-resistant Staphylococcus aureus(MRSA) from adult and pediatric patients were 37.8% (14 208/37 594) and 22.7% (10 874/47 882), respectively. Conclusion Gram-negative bacteria was the main bacteria isolated from respiratory specimens in Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021. The predominant bacterial species isolated from adults and pediatric patients were different. The resistance rates of Escherichia coli, Enterobacter cloacae and Pseudomonas aeruginosa to partial antimicrobial agents decreased year by year. The resistance rate of Klebsiella pneumoniae to carbapenems increased gradually. Continuous and efficient surveillance on antimicrobial resistance should be carried out to provide data basis for clinical antimicrobial use.

Abstract:Objective To understand the distribution and antimicrobial resistance of Staphylococcus spp. isolated from clinical specimens in Hunan Province from 2012 to 2021, provide scientific basis for rational clinical antimicrobial use as well as the formulation and evaluation of management policies for clinical antimicrobial use. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) technical scheme, antimicrobial resistance of Staphylococcus spp. reported by Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021 was analyzed with WHONET 5.6 software. Results From 2012 to 2021, the top 4 isolated Staphylococcus were Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis. Staphylococcus spp. were mainly isolated from specimens of sputum, blood, secretion, wound pus, and urine. Sputum and blood specimens accounting for 25.4%-31.8% and 21.9%-27.8%, respectively. Among all clinically isolated bacteria, Staphylococcus spp. accounted for 15.5%-22.4%, showing a slowly downward trend. In the past 10 years, detection rates of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 35.1% to 24.8%, while detection rates of methicillin-resistant coagulase negative Staphylococcus (MRCNS) increased, but were lower than 70%. Susceptibility rates of Staphylococcus spp. to vancomycin, teicolanin and linezolid were 100%. Conclusion Among clinically isolated Staphylococcus spp. in Hunan Province, the detection rate of MRSA has decreased. Vancomycin-, teicoplanin- and linezolid-resistant Staphylococcus spp. were not found. Management of rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should be strengthened continuously, and antimicrobial resistance surveillance should be conducted well.

Abstract:Objective To understand the distribution and antimicrobial resistance of bacteria from clinical urine specimens in Hunan Province, and provide scientific basis for anti-infection treatment of patients with urinary tract infection (UTI). Methods Bacterial resistance surveillance was carried out according to the technical scheme requirements of China Antimicrobial Resistance Surveillance System, antimicrobial susceptibility testing results were judged based on standard of American Clinical and Laboratory Standards Institute, data about strains and antimicrobial resistance of bacteria from urine specimens reported by member units of Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021 were analyzed with WHONET 5.6 software. Results A total of 379 330 strains of bacteria were isolated from urine specimens in 2012-2021, Gram-negative and Gram-positive bacteria accounted for 75.3% (72.4%-76.0%) and 24.7% (24.0%-27.6%), respectively. The top 5 Gram-negative bacteria were Escherichia coli (48.3%), Klebsiella pneumoniae (8.4%), Proteus mirabilis (3.3%), Pseudomonas aeruginosa (3.0%) and Enterobacter cloacae (1.6%). The top 5 Gram-positive bacteria were Enterococcus faecium (8.1%), Enterococcus faecalis (6.6%), Staphylococcus epidermidis (1.9%), Staphylococcus aureus (1.9%) and Staphylococcus haemolyticus (1.4%). The constituent of bacteria isolated from urine specimens of patients in different gender and age groups were different. Escherichia coli ranked first, accounting for 34.8% and 57.2% in males and females, respectively, as well as 49.0% and 34.4% in adults and children, respectively. Escherichia coli maintained high susceptibility to carbapenems, amikacin, tigecycline, cefoperazone/sulbactam and furantoin, with resistance rate < 10%, while resistance to cefazolin, cefuroxime, ceftriaxone, cefotaxime and quinolones were relatively higher, with resistance rate >48%; resistance rates to ceftazidime, ceftriaxone, cefotaxime, cefepime and aztreonam presented decreased trend (all P < 0.001). Klebsiella pneumoniae maintained higher susceptibility to carbapenems, amikacin and tigecycline, with resistance rate < 11%, resistance rate to quinolones was much lower than that of Escherichia coli. Enterococcus faecium and Enterococcus faecalis maintained high susceptibility to vancomycin, teicoplanin and linezolid, with resistance rates < 5%; resistance rate of Enterococcus faecalis to ampicillin and furantoin was < 15%. Except for linezolid and minocycline, resistance rates of Enterococcus faecium to the other tested antimicrobial agents were all higher than Enterococcus faecalis. No Staphylococcus aureus was found to be resistant to vancomycin, linezolid and teicoplanin. Conclusion Escherichia coli is the main bacteria isolated from urine specimens from various member units of Hunan Province Antimicrobial Resistance Surveillance System. In early empirical treatment, clinical antimicrobial should be targetedly used as early as possible based on bacterial identification and antimicrobial susceptibility testing results, so as to improve treatment effectiveness and slow down the emergence of antimicrobial resistance.

Abstract:Objective To preliminarily evaluate the clinical efficacy of polymyxin combination treatment in patients with ceftazidime/avibactam(CZA)-resistant (inhibition zone diameter of CZA measured by disc diffusion method was ≤22 mm) carbapenem-resistant Gram-negative bacteria (CR-GNB) infection. Methods Hospitalized patients who received polymyxin combination for the treatment of CZA-resistant CR-GNB infection in a hospital from June 2021 to May 2023 were included in the study. According to the antimicrobial susceptibility results of CZA by disc diffusion method, patients were divided into CZA inhibition zone diameter 20-22 mm group and CZA inhibition zone dia- meter < 20 mm group. Clinical efficacy and safety of anti-infection treatment in the two groups of patients were observed. Results A total of 75 patients were enrolled, including 41 patients with CZA inhibition zone diameter 20-22 mm and 34 patients with CZA inhibition zone diameter < 20 mm. The general data between the two groups of patients were not statistically different (all P>0.05). The proportion of the types, dosage and combination regimens of polymyxins between the two groups of patients were not statistically different (all P>0.05). The number of bacterial strains and the diameter of CZA inhibition zone of different types of CR-GNB isolates between the two groups were all statistically different (all P < 0.05). Clinical effective rate, microbiological clearance rate, 28-day mortality, and discharge mortality between the two groups of patients were not statistically different (all P >0.05). Changes in renal safety indexes between the two groups of patients before and after treatment with polymyxins were not statistically different (all P>0.05). Conclusion Clinical and microbiological efficacy of combination treatment with polymyxins for CZA-resistant CR-GNB infected patients is approximately 50%. The efficacy of polymyxin combination in the treatment of infection caused by strains with inhibitory zone diameter < 20 mm is consistent with those with diameter of 20-22 mm, but further validation with a larger size of clinical specimens is needed.

Abstract:Objective To understand the antimicrobial resistance and genetic characteristics of clinically isolated Pseudomonas aeruginosa in Jiangsu area. Methods Pseudomonas aeruginosa isolated from sentinel hospitals in Jiangsu area from 2016 to 2021 were collected, susceptibility of bacterial isolates to 19 kinds of 10 categories of antimicrobial agents were detected with broth dilution method. Bacterial strains were performed whole genome sequencing and multilocus sequence typing, antimicrobial resistance genes were scanned and analyzed through comprehensive antimicrobial resistance database. Results From 2016 to 2021, 101 strains of Pseudomonas aeruginosa isolated from patients at sentinel hospitals in 12 cities were collected through the Pathogenic Bacteria Identification Network. Antimicrobial susceptibility testing results showed that all strains were resistant to 8 kinds antimicrobial agents in 6 categories, including chloramphenicol of amphenicols, compound sulfamethoxazole of sulfonamides, cefotaxime and cefazolin of cephalosporins, tetracycline of tetracyclines, ampicillin and ampicillin/sulbactam of penicillins, as well as amoxicillin/clavulanic acid of β-lactams, 45.54% of the isolates were carbapenem-resistant strains. Resistance rates of two carbapenems imipenem and meropenem were 45.54% and 39.60%, respectively, 63.36% of the strains were resistant to more than 10 kinds of antimicrobial agents. A total of 35 kinds of antimicrobial-resistant phenotypes were found, among which one strain was extensively resistant to 19 antimicrobial agents. The most drug-resistant strain was AMC-AM-SAM-CZ-CTX-C-TE-SXT (31.69%, n=32). Multilocus sequence typing analysis revealed 75 ST types, and clustering analysis revealed that ST 262 was at the center point, with 11 subtypes or branches genetically evolved. Whole genome scanning revealed 18 kinds of 6 categories antimicrobial resistance genes, the carrying status and phenotype of the crpP gene were completely consistent. Conclusion From 2016 to 2021, the clinically isolated Pseudomonas aeruginosa in Jiangsu area showed severe antimicrobial resistance, the resistance rates to two carbapenems and the proportion of strains resistant to more than 10 kinds of antimicrobial agents are higher than other provinces in China and should be paid highly attention.

Abstract:Objective To investigate the application of cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) in the diagnosis of intracranial bacterial infection after pediatric neurosurgery. Methods Clinical data of patients who met the diagnostic criteria for intracranial bacterial infection (including clinical diagnosis and confirmed diagnosis) after neurosurgery in the pediatric intensive care unit of a hospital of Central South University from January 1, 2020 to August 31, 2023 were analyzed. From October 2021, CSF culture and mNGS detection were performed before empirical use of anti-intracranial infection agents, for patients with negative mNGS results of CSF, combined with CSF culture results and clinical data, the empirical anti-intracranial infection treatment was not given or stopped as early as possible, and follow-up was conducted. Results A total of 43 children were included in the analysis, including 38 cases in clinical diagnosis group and 5 cases in pathogen diagnosis group. There were no statistically significant differences in routine and biochemical indicators of CSF detection between the two groups (both P>0.05). Among 38 cases in the clinical diagnosis group, 10 clinically diagnosed cases (control group) received empirical antimicrobial treatment after clinically diagnosed intracranial infection from January 2020 to September 2021; 28 clinically diagnosed cases of intracranial infection had negative results of mNGS pathogen and cerebrospinal fluid culture from October 2021 to August 2023 (intervention group). Sixteen cases didn't receive empirical anti-intracranial infection treatment, and the other 12 cases stopped the empirical anti-intracranial infection treatment in time after the reporting of negative mNGS and combining with clinical data. No bacterial meningitis occurred among the 28 cases during the followed-up, and the average duration (0[0, 4] days) of intracranial antimicrobial use was shorter than that of the 10 clinically diagnosed cases in the control group (8[7, 11] days, P < 0.05). Conclusion CSF mNGS can improve the pathogen detection rate of intracranial bacterial infection after neurosurgery, and the detection result of mNGS can help guide the rational use of antimicrobial agents in the clinically diagnosed intracranial bacterial infection after neurosurgery.

Abstract:Objective To explore the clinical characteristics, laboratory examination and prognostic risk factors of invasive pulmonary aspergillosis (IPA). Methods Clinical data of IPA patients in a hospital from September 2020 to June 2023 were retrospectively analyzed. Clinical characteristics and prognostic risk factors of patients were analyzed. Results A total of 111 patients with IPA were analyzed, aged (68.8±12.5) years old, mainly male (63.1%), and were mainly distributed in the department of respiratory diseases, intensive care unit (ICU), departments of hematology and infectious diseases, accounting for 75.6% in total. The common Aspergillus in IPA were Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger, accounting for 67.6%, 19.8% and 4.5% respectively. The positive rates of (1, 3)-β-D-glucan antigen test (G test)and galactomannan antigen test (GM test) for bronchoalveolar lavage fluid (BALF) were 73.7% and 68.0%, respectively. Of 111 IPA patients, 32 (28.8%) had poor prognosis and 25 (22.5%) were complicated with viral infection. Multivariate logistic regression analysis showed that combined with viral infection (OR [95%CI]: 4.535 [1.385-14.846], P=0.012), glucocorticoid use history for 3 consecutive weeks (OR [95%CI]: 9.128 [2.293-36.341], P=0.002), mechanical ventilation (OR [95%CI]: 4.690 [1.100-19.990], P=0.037) and indwelling urinary catheter (OR [95%CI]: 7.144 [1.345-37.950], P=0.021) were independent risk factors for poor prognosis in IPA patients. Conclusion Multiple factors are related to the poor prognosis of IPA, and multiple methods should be combined to perform early identification and rational treatment for improving patient prognosis, corresponding preventive measures should be taken to avoid the occurrence of healthcare-associated infection.

Abstract:Objective To analyze the clinical infection characteristics, detection rates of antimicrobial resistance and virulence genes, as well as biofilm formation ability of T6SS-positive carbapenem-resistant Klebsiella pneumoniae (CRKP), provide reference for clinical prevention and control of CRKP infection. Methods Clinically isolated CRKP strains and patients' data from a tertiary first-class hospital in Anhui Province from January 2019 to December 2022 were collected. T6SS genes, virulence genes, antimicrobial resistance genes, and molecular typing were detected with polymerase chain reaction method. Biofilm formation ability was detection with 96-well plate crystal violet staining method. Results A total of 160 CRKP strains were included in study. The main sources of specimens were sputum (46.9%) and blood (26.3%). CRKP strains exhibited multidrug-resistant phenotype, mainly carrying bla_KPC (80.6%), followed by bla_NDM (17.5%). CRKP were divided into T6SS-positive group (n=129, 80.6%) and T6SS-negative group (n=31, 19.4%) based on whether they carried T6SS. The proportion of patients with chronic pulmonary and heart diseases in T6SS-positive group was higher than that in T6SS-negative group (P < 0.05), and the prognosis was worse than negative group (P < 0.05). In T6SS-positive group, the detection rates of iucA, mrkD, rmpA2, peg344, wabG, and fimH were all higher than those in T6SS-negative group (all P < 0.05). The main type in CRKP was ST11 (68.8%), with K64-ST11 accounting for 70.9% and K47-ST11 accounting for 25.5%. The proportions of ST11 CRKP and K64-ST11 CRKP in T6SS-positive group were both higher than T6SS-negative group (both P < 0.05). Biofilm formation ability of CRKP in T6SS-positive group was stronger than T6SS-negative group (P < 0.001). Except bla_OXA-48 gene, there was no statistical difference in carrying of other carbapenem resistance genes and antimicrobial resistance rates between the two groups. Conclusion CRKP in this area exhibits multidrug resistance, with a higher detection rate of T6SS. T6SS-positive CRKP has a higher detection rate of virulence genes and stronger biofilm formation ability.

Abstract:Objective To compare the economic benefits of electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) in hand hygiene (HH) compliance, and provide reference for HH monitoring methods in high-risk clinical departments. Methods Eleven high-risk departments, including pulmonary and critical care medicine, department of trauma and micro-orthopedics, pediatric intensive care unit, department of infectious diseases, department of joint and sports medicine, general ward of pulmonary and critical care medicine, department of neurology, department of neurosurgery, department of radiochemotherapy for esophageal and mediastinal tumor lymphoma, department of radiochemotherapy for head, neck and children's tumor, and department of hematology in a large tertiary first-class hospital were analyzed. A decision tree model was constructed using TreeAge Pro 2022 software to calculate cost-effectiveness, cost-efficiency, Hawthorne effect, and indirect cost-benefit of the cost input and effect output during the implementation period of the two monitoring methods from December 2022 to May 2023. Results The total cost of the ESM method was lower than that of the MPM method (4 868.55 Yuan vs 7 122.12 Yuan), but HH compliance rate of the ESM method was lower than that of the MPM method (61.33% vs 78.79%). The cost-effectiveness ratio of MPM method was higher than that of ESM method (9 039.37 Yuan vs 7 938.28 Yuan), with an incremental cost-effectiveness ratio of 17.46%. The cost-efficiency ratio of MPM method was significantly higher than that of ESM method (72 013.35 Yuan vs 8 813.45 Yuan). The Hawthorne effect of MPM method was higher than that of ESM method (59.45% vs 47.90%). The cost-benefit ratio of MPM method was lower than that of ESM method (2 894.70 Yuan vs 4 765.98 Yuan). When the payment willingness was less than 18 500 Yuan, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness. Conclusion For high-risk infection control departments, the ESM method is superior to MPM in cost-effectiveness, cost-efficiency and cost-benefit, but there is no statistically significant difference in the Hawthorne effect between the two methods.

Abstract:Objective To evaluate the effect of comprehensive intervention measures on hand hygiene (HH) compliance of health care workers (HCWs) with the interrupted time-series (ITS) analysis. Methods Staff from all clinical and technical departments of a tertiary hospital were selected as the research subjects, during the preparation period for the tertiary hospital accreditation, HH comprehensive intervention measures, including training, investigation, competition, and etc.were implemented.The monitoring data of HH compliance before and after intervention were collected, and the ITS analysis was applied to construct a model for evaluating the immediate and long-term effect of intervention. Results HH compliance rate of HCWs increased from 67.58% before intervention to 81.43% after intervention.ITS analysis result showed that overall HH compliance rate of HCWs increased by 19.717%(t=5.473, P < 0.001) immediately after the intervention, but the slope change was-1.995(t=-2.249, P=0.048), indicating an expanding downward trend in HH compliance after implementation of intervention.The intervention had immediate improvement effect on staff with different jobs, with the doctor group having the greatest improvement.The slope change for staff with different jobs was negative, with the absolute value of the change for the nurse group being the smallest. Conclusion Comprehensive intervention measures can effectively improve HH compliance of HCWs, but the long-term effect is not ideal.ITS model can be effectively used to analyze the monitoring data of HH compliance.

Abstract:Objective To understand the healthcare-associated infection (HAI) and device-associated infection in the intensive care units (ICU), and provide scientific basis for HAI management. Methods HAI monitoring data of patients in ICU in a tertiary first-class hospital from January 2019 to December 2021 were collected and conducted statistical analysis. Results A total of 2 302 patients were monitored, and 120 patients (138 cases) had HAI.Incidence and cases incidence of HAI were 5.21% and 5.99% respectively.There were no statistically significant differences in incidence of HAI and case incidence of HAI in 2019-2021(all P>0.05).The main HAI site was lower respiratory tract (n=96 cases, 69.57%), followed by the urinary tract (n=28 cases, 20.29%) and bloodstream (n=6 cases, 4.35%).A total of 125 strains of pathogens were isolated, with Gram-negative bacteria being the main strain, accounting for 74.40%.The incidence of central catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) were 0.34‰, 1.47‰, and 8.65‰, respectively.Over the past three years, the incidence of device-associated infection decreased and VAP decreased significantly (both P < 0.05).Among healthcare-associated non-device-associated infection, the proportion of pulmonary infection increased from 23.53% to 46.00%, with a statistically significant difference (P < 0.05). Conclusion Three consecutive years of targeted monitoring showed that the incidence of catheter-associated infection decreased, but the incidence of non-device-associated infection increased.HAI management should strength the monitoring of the implementation of HAI prevention and control measures for non-mechanically ventilated patients, so as to reduce the overall incidence of HAI in ICU.

Abstract:Objective To establish a risk assessment system for infection control in oral outpatient department, grasp the high risk factors, and provide direction for the continuous improvement of infection control measures in oral diagnosis and treatment. Methods Based on the Delphi expert consultation method, clauses in national industry standards and specifications related to infection control in oral outpatient department were captured, and a risk assessment system was established, healthcare-associated infection risks of outpatient department of a tertiary stomatological specialty hospital were evaluated, high-risk points were quantitatively obtained with the failure mode and effect analysis method. Results The risk assessment system for infection control in oral outpatient department was established, including 3 first-level indexes, 15 second-level indexes and 74 third-level indexes.A total of 18 risk points were identified, including incorrect hand hygiene opportunities of health care workers, incorrect cleaning and disinfection methods for cleaning appliances, lower hand hygiene compliance rate than the hospital-wide baseline, non-timely disinfection for containers and areas of fabrics after use, unclear use location of cleaning appliances, incomplete or incorrect infection control system, irregular monitoring of ultraviolet lamp irradiation intensity, overloading of medical waste, without quality assessment on cleaning and disinfection, as well as incorrect wearing or removal of protective equipment. Conclusion The method for risk index system for infection control in the oral outpatient department is initially established, and the possible high-risk points in the implementation of infection control measures in the oral outpatient department are identified, which provide reference for the continuous improvement of infection control in the oral outpatient department.

Abstract:Objective To investigate the frailty status and influencing factors in people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS)(PLWHA). Methods PLWHA aged ≥18 years in a hospital in Changsha City from June to August 2019 were selected as the study subjects.The basic condition and frailty of the subjects were evaluated by self-designed questionnaire and Tilburg frailty indicator, respectively. Results The incidence of frailty in PLWHA was 26.4%, logistic regression analysis showed that patients with infection years >5 years had a 2.33 times higher risk of frailty compared with patients with infection years ≤5 years (95%CI: 1.24-4.37, P=0.009).The risk of frailty in patients with a highest HIV load of ≥ 100 000 copies/mL was 1.40 times higher than in patients with a highest HIV load of < 100 000 copies/mL (95%CI: 1.05-1.85, P=0.022).The risk of frailty in patients with CD4⁺T lymphocyte count < 200 mm³ was 3.60 times higher than that in patients with CD4⁺T lymphocyte count ≥200 mm³(95%CI: 1.96-6.62, P < 0.001). Conclusion PLWHA with longer duration of HIV infection, lower CD4⁺T lymphocyte count and higher HIV load are more prone to develop frailty.

Abstract:A 58-year-old male patient with decompensated cirrhosis after hepatitis B and type Ⅱ diabetes for 12 years was admitted to hospital due to abdominal distension, edema and oliguria in recent one month. During hospitalization period, the patient experienced chills and fever, blood specimens were taken for culture, empirical anti-infection treatment with cefoperazone/sulbactam was given. The diagnosis of bloodstream infection caused by non-O1/O139 Vibrio cholerae was confirmed, antimicrobial susceptibility testing indicated that cefoperazone/sulbactam was sensitive, current antimicrobial agent was continued, cefoperazone/sulbactam 3 g q12h was changed to 3 g q8h treatment. After 10 days, the patient had no fever, blood and fecal cultures were negative for Vibrio cholerae, condition was improved and patient was discharged from the hospital.

Abstract:The excessive use and abuse of antimicrobial agents have led to the emergence of multidrug-resistant organism (MDRO). MDRO infection is becoming increasingly severe and difficult to treat, it is urgent to find new drugs for the treatment of MDRO infection. Chinese herbal medicine is a unique natural resource in China, with advantages of low drug resistance, low toxicity and low price, it has good inhibitory effect on MDRD, and can exert inhibitory effect through various mechanisms.This article collects and sorts out relevant literatures at home and abroad, and reviews inhibitory effect and mechanisms of single traditional Chinese medicine, traditional Chinese medicine compound, and traditional Chinese medicine combined with antimicrobial agents on MDRO, so as to provide theoretical basis for the research of drugs against MDRO.

Abstract:Staphylococcus aureus (SA) is one of the common pathogens causing healthcare-associated infection, which easily adheres to the surface of catheters or implants to form biofilm, leading to increased antimicrobial resis-tance, and posing great challenge to clinical treatment. In recent years, studies have shown that antimicrobial agents at sub-minimum inhibitory concentration(sub-MIC) can affect the biofilm formation of SA. This paper elaborates the formation process and gene regulation of SA biofilm, as well as the effect and mechanisms of different antimicrobial agents at sub-MIC on SA biofilm formation, so as to provide basis for effective control and treatment of SA biofilm-related infection.

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