Implications of deduplication on the detection rates of multidrug-resistant organism (MDRO) in various specimens: insights from the hospital infection surveillance program.

BACKGROUND: Currently, different guidelines recommend using different methods to determine whether deduplication is necessary when determining the detection rates of multidrug-resistant organisms (MDROs). However, few studies have investigated the effect of deduplication on MDRO monitoring data. In this study, we aimed to investigate the influence of deduplication on the detection rates of MDROs in different specimens to assess its impact on infection surveillance outcomes. METHODS: Samples were collected from hospitalized patients admitted between January 2022 and December 2022; four types of specimens were collected from key monitored MDROs, including sputum samples, urine samples, blood samples, and bronchoalveolar lavage fluid (BALF) samples. In this study, we compared and analysed the detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CRECO), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA) under two conditions: with and without deduplication. RESULTS: When all specimens were included, the detection rates of CRKP, CRAB, CRPA, and MRSA without deduplication (33.52%, 77.24%, 44.56%, and 56.58%, respectively) were significantly greater than those with deduplication (24.78%, 66.25%, 36.24%, and 50.83%, respectively) (all P < 0.05). The detection rates in sputum samples were significantly different between samples without duplication (28.39%, 76.19%, 46.95%, and 70.43%) and those with deduplication (19.99%, 63.00%, 38.05%, and 64.50%) (all P < 0.05). When deduplication was not performed, the rate of detection of CRKP in urine samples reached 30.05%, surpassing the rate observed with deduplication (21.56%) (P < 0.05). In BALF specimens, the detection rates of CRKP and CRPA without deduplication (39.78% and 53.23%, respectively) were greater than those with deduplication (31.62% and 42.20%, respectively) (P < 0.05). In blood samples, deduplication did not have a significant impact on the detection rates of MDROs. CONCLUSION: Deduplication had a significant effect on the detection rates of MDROs in sputum, urine, and BALF samples. Based on these data, we call for the Infection Prevention and Control Organization to align its analysis rules with those of the Bacterial Resistance Surveillance Organization when monitoring MDRO detection rates.

The symptoms and interval of Omicron SARS-CoV-2 reinfection among healthcare workers in a hospital of Southern China: a cross-sectional study.

BACKGROUND: The prevalence and distinction between first Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reinfection with the Omicron variant among healthcare workers (HCWs) remain unclear. METHODS: A cross-sectional study was conducted at a hospital in Southern China. The study included 262 HCWs who were infected with SARS-CoV-2 between April and June 2023, with 101 cases of first infection and 161 ones of reinfection. Student's t-test, Analysis of Variance (ANOVA), and Mann-Whitney U tests were used based on the distribution of quantitative variables. Pearson's chi-square and Fisher's exact tests were used based on the expected frequencies of categorical variables. RESULTS: The reinfection rate among HCWs was 11.5% (161/1406). The majority of the infected HCWs were female (212/262, 80.9%, first infection vs. reinfection: 76.2% vs. 83.9%). The nursing staff, had the highest percentage of SARS-CoV-2 infection (42.0%), especially of its reinfection (47.8%). Out of the 262 infected individuals, 257 had received SARS-CoV-2 vaccination, primarily inactivated vaccines (243/257, 91.1%). The first infection group, which received four doses (24, 23.8%), was significantly higher than that in the reinfection group (6, 3.7%) (P < 0.001). The proportion of asymptomatic infections among HCWs in the two groups was 1.0% and 1.2%. The main symptoms during the first infection and reinfection were fever (83.2% and 50.9%) and sore throat (78.2% and 77.0%). There were significant differences in the prevalence of fever (83.2% vs. 50.9%), rhinorrhea (45.5% vs. 60.9%) and myalgia (56.4% vs. 37.9%) between the first infection and reinfection (P < 0.05). The average interval for SARS-CoV-2 reinfection was 149.9 (range: 114-182, SD = 11.9) days. Notably, physicians had the shortest average interval of 142.8 (8.8) days, while management and administrative staff had the longest average interval of 153.8 (13.5) days. CONCLUSIONS: Although the symptoms of HCWs during reinfection with SARS-CoV-2 were milder, the high reinfection rate and short interval between infections indicate the need to enhance monitoring and protective measures for HCWs during the epidemic.

Fever clinic construction and management targeted to prevention and control of healthcare-associated respiratory viral infections in Jiangsu, China: A cross-sectional observational study.

To analyze the post-COVID-19 construction and management of fever clinics targeted to prevention and control of healthcare-associated respiratory viral infections in medical institutions at all levels in China, and to provide a basis for promoting their standardized construction, we conducted this survey on the construction of fever clinics in 429 medical institutions of Jiangsu Province from July to December 2020. Contents of the questionnaire included the general situation of medical institutions, the construction status and future construction plans of fever clinics. We find the construction rate of fever clinic in medical institutions of Jiangsu province was 75.3%. All construction indicators, quality management systems and processes fail to fully meet the requirements of documents and standards. Jiangsu province actively promotes the construction of fever clinic layout, but there is still a gap with the construction standard. As a result, it is necessary to further promote standardized construction of fever clinic, and necessary financial input should be increased to expand all constructions of fever clinic in primary medical institutions.

Antibiotic prophylaxis after 48 h postoperatively are not associated with decreased surgical site infections and other healthcare associated infections in pancreatic surgery patients: a retrospective cohort study.

BACKGROUND: It is controversial whether antibiotic should be used prophylactically 48 h after pancreatic surgery. Hence, the association of antibiotic prophylaxis (AP) after 48 h postoperatively with the incidence of surgical site infections (SSIs) and other healthcare-associated infections (HAIs) in patients receiving pancreatic surgery was evaluated. METHODS: A retrospective cohort analysis was performed on 1073 patients who underwent pancreatic surgery. These patients were categorized into the non-AP after 48 h postoperatively group (n = 963) and the AP after 48 h postoperatively group (n = 110) based on whether or not they obtained AP from 48 h to 30 days after surgery. Outcomes included SSIs and other HAIs. RESULTS: The incidence of SSIs in the non-AP after 48 h postoperatively group (98/963, 10.2%) was notably lower than that in the AP after 48 h postoperatively group (22/110, 20.0%) (P = 0.002). Other HAIs incidence was not significantly different between the non-AP after 48 h postoperatively group (77/963, 8.0%) and the AP after 48 h postoperatively group (11/110, 10.0%) (P = 0.468). Multiple regression analysis demonstrated that AP after 48 h postoperatively was a risk factor for SSIs (OR = 2.14, 95% CI 1.28-3.59) but not for other HAIs (OR = 1.24, 95% CI 0.63-2.42) after adjustment for age, gender, and diabetes. Subsequent to adjustment for all confounding factors, AP after 48 h postoperatively was not a influence factor for SSIs (OR = 2.13, 95% CI 0.76-5.99) and other HAIs (OR = 3.69, 95% CI 0.99-13.81). CONCLUSIONS: AP after 48 h postoperatively following pancreatic surgery was not associated with the lower morbidity rate of SSIs and other HAIs. Nonetheless, this study may facilitate further development of strategies towards standardization of the duration of AP management of pancreatic surgery.

Environmental Contamination of SARS-CoV-2 Delta VOC by COVID-19 Patients Staying in the Hospital for More Than Two Weeks.

Background: Patients infected with SARS-CoV-2 Delta VOC have a longer course of disease. We detected the air, surfaces, and patient's personal items in the wards of the second hospital of Nanjing during the outbreak of the COVID-19 Delta Variant to identify the environmental contamination, which provides a theoretical basis for the prevention and control of COVID-19 variation beads in the future. Methods: In the cross-sectional study, we collected and analyzed clinical features, demographic and epidemiological data, laboratory and swab test results, and surface and air samples of 144 COVID-19 cases. Results: The time from symptom onset to surface sampling was 25 days (IQR, 21 to 33 days). Positive throat swabs were detected in 52(36.1%) patients, of which only 8(5.6%) patients had N or ORF1a/b genes Ct value <35 on the surface sampling day. Among the 692 environmental surface and air specimens collected from 144 COVID-19 cases, 3 specimens (3/692, 0.4%) related to 5 cases (3.5%, 5/144) were detected positive on RT-PCR. Overall, bedside tables (2/144, 1.4%) were most likely to be contaminated, followed by toilet seats (1/81, 1.2%). Conclusion: The environmental contamination by SARS-CoV-2 Delta VOC-infected cases with disease duration of more than two weeks is limited.

Genome-wide mapping of DNase I hypersensitive sites in pineapple leaves.

Pineapple [Ananas comosus (L.) Merr.] is the most economically important crop possessing crassulacean acid metabolism (CAM) photosynthesis which has a higher water use efficiency by control of nocturnal opening and diurnal closure of stomata. To provide novel insights into the diel regulatory landscape in pineapple leaves, we performed genome-wide mapping of DNase I hypersensitive sites (DHSs) in pineapple leaves at day (2a.m.) and night (10a.m.) using a simplified DNase-seq method. As a result, totally 33340 and 28753 DHSs were found in green-tip tissue, and 29597 and 40068 were identified in white-base tissue at 2a.m. and 10a.m., respectively. We observed that majority of the pineapple genes occupied less than two DHSs with length shorter than 1 kb, and the promotor DHSs showed a proximal trend to the transcription start site (>77% promotor DHSs within 1 kb). In addition, more intergenic DHSs were identified around transcription factors or transcription co-regulators (TFs/TCs) than other functional genes, indicating complex regulatory contexts around TFs/TCs. Through combined analysis of tissue preferential DHSs and genes, we respectively found 839 and 888 coordinately changed genes in green-tip at 2a.m. and 10a.m. (AcG2 and AcG10). Furthermore, AcG2-specific, AcG10-specific and common accessible DHSs were dissected from the total photosynthetic preferential DHSs, and the regulatory networks indicated dynamic regulations with multiple cis-regulatory elements occurred to genes preferentially expressed in photosynthetic tissues. Interestingly, binding motifs of several cycling TFs were identified in the DHSs of key CAM genes, revealing a circadian regulation to CAM coordinately diurnal expression. Our results provide a chromatin regulatory landscape in pineapple leaves during the day and night. This will provide important information to assist with deciphering the circadian regulation of CAM photosynthesis.

Characteristics of Virulent ST5-SCCmec II Methicillin-Resistant Staphylococcus aureus Prevalent in a Surgery Ward.

Objective: To investigate the transmission pathway of a MRSA prevalence in a pancreatic surgery ward in a Chinese teaching hospital. Methods: Molecular epidemiology investigations were carried out combined PFGE, MLST, SCCmec typing and whole-genome sequencing for 20 successive MRSA isolates (2 isolates from the ward environment). Resistance and virulence genes were detected using specific PCR. Bacterial identification and AST were performed using the Vitek 2 Compact System. Clinical data of enrolled cases were retrieved from electronic case records. Results: From January 2020 to May 2020, successive isolated 20 MRSA strains were clarified to 2 PFGE patterns (A = 19, B = 1) in the ward. Both isolates from environment and patients belonged to sequence type ST5-SCCmec II-spa type t311. MRSA-related resistance genes mecA, blaZ, ermA, ant(4')-Ia and norA were found in each clone. All 20 isolates carried tst, hlg, hla, eta, eap, fnbA and seo virulence genes, other virulence genes such as sea, sec, seb, seg, sei, sem, sen, ebpS and fnbB were also found in partial stains. All patients had fever symptom, 27.8% were accompanied by diarrhea, 88.9% had undergone surgery or invasive procedures within 30 days. Finally, 94.4% of these patients recovered. Conclusion: This study confirmed a prevalence of ST5-MRSA-II-t311 clone in a surgery ward, indicated MRSA is a risk factor for post-surgery nosocomial infection and hand hygiene and environmental surveillance should not be ignored.

Characteristics and Occurrence Scenarios of Staff Exposed to SARS-CoV-2 Omicron in Shanghai Lingang Fangcang Shelter Hospital, CHINA.

Objective: To analyze the characteristics and occurrence scenarios of occupational exposure of staff in the Shanghai Lingang Fangcang Shelter Hospital. Methods: We collected the data of 80 staff with occupational exposure (including doctors, nurses, cleaning, security guards, and maintenance staff) in the Shanghai Lingang Fangcang Shelter Hospital from April 5 to May 20, 2022. The basic information of occupational exposure, factors influencing different occupational exposure types, ways to discover occupational exposure, discovery places of occupational exposure, and specific occurrence scenarios were compiled and analyzed among these data. Results: Occupational exposure mainly occurred in nurses (37, 46.25%), and cleaning (21, 26.25%). After the occurrence of occupational exposure, 20 staff (25%) did not know the occurrence time. Moreover, occupational exposure types were listed from high to low proportion as follows: broken protective clothing (56, 70%), mask loosening or displacement (13, 16.25%), skin exposure (6, 7.5%), and sharp object injuries (5, 6.25%). Occupational exposure was discovered mainly through self-discovery (56, 70%), while other discovery ways were majorly colleague discovery (12, 15%) and infection control supervisor discovery (12, 15%). Furthermore, occupational exposure was discovered principally in the public area (53.75%) and the office area (25%) of the cabin, but the proportion of mask loosening or displacement (38.46%) and skin exposure (50%) was also high in the first unloading area. Broken protective clothing occurred in the following scenarios: scratching while working in the cabin (37, 66.07%) and not knowing its occurrence time (25%). The occurrence scenarios of mask loosening or displacement were mainly not knowing its occurrence time (6, 46.15%), self-discovery (3, 23.08%), and at the time of removal (3, 23.08%). Conclusion: Targeted training and prevention of occupational exposure should be performed to decrease infection risk and ensure staff safety in Fangcang shelter hospitals.

Diversity of Circulating NKT Cells in Defense against Carbapenem-Resistant Klebsiella Pneumoniae Infection.

Nosocomial infection caused by carbapenem-resistant Klebsiella pneumonia (CRKP) infection has become a global public health problem. Human NK and NKT cells in peripheral immune responses are recognized as occupying a critical role in anti-bacterial immunity. Through performed scRNA-seq on serial peripheral blood samples from 3 patients with CRKP undergoing colonization, infection, and recovery conditions, we were able to described the immune responses of NK and NKT cells during CRKP infection and identified a mechanism that could contribute to CRKP clearance. The central player of CRKP infection process appears to be the NKT subset and CD56hiNKT subset which maintained immune competence during CRKP colonization. With time, CRKP leads to the loss of NK and CD160hiNKT cells in peripheral blood, resulting in suppressed immune responses and increased susceptibility to opportunistic infection. In summary, our study identified a possible mechanism for the CRKP invasion and to decipher the clues behind the host immune response that influences CRKP infection pathogenesis.

Study on the Detection and Infection Distribution of Multidrug-Resistant Organisms in Different Specimens.

Objective: To analyze the infection and distribution of multidrug-resistant organisms (MDRO) in different clinical specimens, thereby providing a reference for clinical diagnosis and treatment and prevention and control. Patient and Methods: 2314 strains of MDRO isolated from clinical specimens in the First Affiliated Hospital of Nanjing Medical University from January to December 2020. MDRO were collected by Information System. The detection rate of MDRO, infection rate, the proportion of infection, and detection rate of MDRO infection in different specimens were analyzed. Results: The top three specimens in the detection rate of MDRO were BALF (60.71%), sputum (33.68%), and blood (28.79%). The top three specimens in the proportion of MDRO infection were blood (97.74), other sterile body fluids (90.35%), and BALF (90.20%). The top three specimens in the MDRO infection rate were BALF (9.75%), sputum (3.07%), and secretions (2.90%). The top three specimens in the detection rate of MDRO infection were sputum (0.63‰), other sterile body fluids (0.13‰), and secretions (0.11‰). Conclusion: The detection and infection distribution of MDRO vary greatly in different specimens. The submission of sterile body fluids for examination should be strengthened and the standard of sample collection should be highlighted.

Nongenomic effects and mechanistic study of butyl benzyl phthalate-induced thyroid disruption: Based on integrated in vitro, in silico assays and proteome analysis.

Based on in vitro and in silico assays as well as proteome analysis, this study explored the nongenomic mechanism for butyl benzyl phthalate (BBP)-induced thyroid disruption. Molecular docking simulations showed that BBP could dock into the Arg-Gly-Asp (RGD) domain of integrin αvß3 and form hydrogen bonds with a docking energy of -35.80 kcal/mol. This chemical enhanced rat pituitary tumor cell (GH3) proliferation and exhibited thyroid hormone-disrupting effects at 5-10 µmol/L. Meanwhile, BBP upregulated ß3 gene expression and activated the downstream mitogen-activated protein kinase (MAPK) pathway in GH3 cells. Interestingly, GH3 cell proliferation was attenuated by integrin αvß3 inhibitor (RGD peptide) or ERK1/2 inhibitor (PD98059), suggesting that the disruptions might be partly attributed to its interaction with integrin αvß3 and activation of MAPK. Furthermore, quantitative proteomic analysis of zebrafish embryos exposed to BBP at an environmentally relevant concentration of 0.3 µmol/L revealed that BBP perturbed proteins and pathways related to cell communication (e.g., integrin binding) and signal transduction (e.g., MAPK signaling pathway). Taken together, our results supported that the biological effects of BBP-activated integrin αvß3 mediated by the nongenomic pathway play an important role in its thyroid disruption. CAPSULE: The nongenomic pathway plays a vital role in the thyroid disruption-inducing actions of BBP.

Assessing alterations of water level due to environmental water allocation at multiple temporal scales and its impact on water quality in Baiyangdian Lake, China.

Lakes in arid/semiarid regions face problems of insufficient inflow and degradation of water quality, which threaten the health of the lake ecosystem. Baiyangdian Lake (BYDL), the largest lake in the North China Plain, is confronted with such challenges. The objective of this study was to improve understanding of how changes in water level influence water quality in the BYDL at different temporal scales, especially related to implementations of intermittent environmental water allocation activities in the past two decades, by using data on monthly lake water level, climate factors of precipitation and temperature, and lake water quality. The Mann-Kendall method and continuous wavelet analysis revealed that the lake water level shows a significant decreasing trend after 1967, and the period of 16-year was identified as the principal period for 1950-2018. Based on cross-wavelet transform and wavelet coherence analysis, the periodic agreement and coherence between water level and climatic factors decreased after 1997, when environmental water allocations started, indicating that the influences of climatic factors, i.e., precipitation and temperature, became weak. By utilizing the cross-wavelet transform and wavelet coherence analysis methods, the relationships between lake water level and water quality parameters of chemical oxygen demand, ammonia nitrogen, total nitrogen, and total phosphorus were investigated. We found that the change in source and amount of environmental water allocation is one possible reason for the temporal evolution in joint variability between lake water level and water quality. Meanwhile, a dilution effect of freshwater allocated to BYDL was detected in the time-frequency domain. However, the result also indicates that the driving mechanism of water quality is complex due to the combined impacts of water allocation, nonpoint source pollution in the rainy season, and nutrient release from lake sediment. Our findings improve the general understanding of changes in water level in lakes located in arid and semiarid regions under climate change and intensive human activities, and also provide valuable knowledge for decision making in aquatic ecosystem restoration of BYDL and other similar lakes.

Effect Analysis of "Four-Step" Training and Assessment Tool in the Prevention and Control of COVID-19.

Purpose: To improve the ability of infection prevention and control (IPC) of medical staff during the COVID-19 epidemic period, the "four-step" mode of whole staff training and assessment was used. Methods: During the period from March 9 to March 18, 2020, 5425 medical staff from The First Affiliated Hospital of Nanjing Medical University were selected as the objects of this study. There are four stages in the training assessment mode. The first stage is the basic assessment stage; the second stage releases the electronic version of the knowledge point manual; the third stage conducts online exercises; the fourth stage conducts the final assessment. Results: In the first stage, the participation rate of medical staff was 95.04%. In the fourth stage, the participation rate of medical staff was 98.01%. The average score of female medical staff in the first stage and the fourth stage was higher than that of males (P< 0.001). The average score of medical staff under 30 years old in the first stage and the fourth stage was higher than that of other age groups (P< 0.05). In the fourth stage, the correct rate of each part of exercises in the knowledge points of IPC was higher than that in the first stage (P< 0.001). In the two stages, the two parts of "COVID-19 prevention and control" and "multi-drug resistant bacteria prevention and control" had the highest accuracy, while the "disinfection and sterilization" and "infectious disease management" had the lowest accuracy (P< 0.001). Conclusion: The "four-step" infection control training assessment mode has realized "full participation" and "effective training", and the level of medical staff's IPC has been significantly improved.

Analysis of influenza trend and impact of COVID-19 in Kezhou, Xinjiang for 8 consecutive years.

To study the trend of influenza and the impact of coronavirus disease 2019 (COVID-19) in Kezhou, Xinjiang from 2013 to 2020. The data of influenza in Kezhou, Xinjiang from January 1, 2013, to December 31, 2020, were collected by the China Influenza Surveillance Information System to study the trend of ILI proportion, the distribution of influenza-like cases in different age groups, the positive cases and positive rate of influenza, and the trend of different influenza subtypes, and to analyze the impact of COVID-19 epidemic on influenza. The proportion of ILI in the Xinjiang Kezhou area was mainly children under 15 years old, and children under 5 years old accounted for the largest proportion. The proportion of ILI, the number of influenza-positive cases, and the influenza-positive proportion were mainly in winter and spring, especially in December and January each year. At the same time, this study found that the overall trend of H3N2 influenza in this region was on the rise, and the outbreaks in 2018 and 2019 were dominated by novel H1N1 and H3N2, respectively. The trend of influenza in Kezhou, Xinjiang is on the rise, and the prevention and control measures of COVID-19 have significantly reduced the data of influenza. It is necessary to strengthen the vaccination work and maintain the basic prevention and control measures of respiratory infectious diseases to prevent and control influenza more effectively.

Neural-Networks-Based Prescribed Tracking for Nonaffine Switched Nonlinear Time-Delay Systems.

In this article, by using the neural-networks (NNs) separation and approximation technique, an adaptive scheme is presented to deliver the prescribed tracking performance for a class of unknown nonaffine switched nonlinear time-delay systems. The nonaffine terms are indifferentiable and the controllability condition is not required for each subsystem, which allows the considered tracking problem to not be efficiently solved by the traditional adaptive control algorithms. To solve the problem, NNs are utilized to separate and approximate the nonaffine functions, and then the dynamic surface control and convex combination method are utilized to construct a controller and a switching strategy. In addition, an adaptive law is considered for each subsystem to reduce the conservativeness. Under the designed controller and switching strategy, all the signals of the resulting closed-loop system are bounded, and the tracking performance is achieved with a prescribed level.

Hospital expenses of nosocomial infection associated with extracorporeal membrane oxygenation in China: a retrospective cohort study.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a highly invasive procedure and a high-cost medical measure, but the economic impact of nosocomial infection after ECMO support remains largely uninvestigated. METHODS: We constructed a retrospective cohort of all patients hospitalized at the First Affiliated Hospital of Nanjing Medical University from 2013 to 2020 who had ECMO supported clinical samples. Propensity score matching (PSM) was used to control the impact of potential confounding variables, including demographics, commodities, and treatment, and to estimate the economic burden of nosocomial infection after ECMO support. RESULTS: There were 194 patients with ECMO support, 136 patients had no infection after ECMO, 38 patients had infection after ECMO, of which 97.4% was lower respiratory tract infection. Compared with patients among ECMO non infection group, the main reasons for ECMO treatment of patients among ECMO infection group were supportive treatment of cardiac dysfunction (63.16% vs. 42.31%, P=0.021) and longer use of catheter (13.74±14.97 vs. 15.97±14.33 days, P=0.034). The total hospital expenses for patients among ECMO infection group and ECMO non infection group were about $55,878 and $51,277 respectively. Patients with ECMO infection had significantly higher radiate expenses, operational expenses and anesthetic expenses than those among ECMO non infection group ($119.06 vs. $69.32, P=0.025; $6,458.81 vs. $4,882.49, P=0.034; $331.62 vs. $145.56, P=0.030). CONCLUSIONS: Our study demonstrates that the incidence of nosocomial infection after ECMO support was relatively high, which did not lead to high total hospital expenses, but lead to higher radiate expenses, operational expenses and anesthetic expenses.

The Distribution and Source of MRDOs Infection: A Retrospective Study in 8 ICUs, 2013-2019.

BACKGROUND: To analyze the distribution and source of MDROs infection in the ICUs and to provide a basis for formulating more effective prevention and control programs for MDROs. METHODS: A retrospective investigation was conducted on MDROs infection in 8 ICUs of a large tertiary hospital from July 2013 to June 2019. A total of 2629 strains of MDROs isolated from 1701 inpatients were selected for analysis. The MDROs of the 8 ICUs were divided into two types of four categories according to source: out-of-hospital (out-of-hospital transfer and community acquisition) and in-hospital (in-hospital transfer and department acquisition) infections. RESULTS: CRAB (41.84%) and CRE (35.07%) accounted for the majority of the infecting MDROs. The detection rates of MRSA, CRAB, CRPA and CRE were 61.24%, 83.75%, 43.01% and 30.15%, respectively. The top three infection sites of MDROs were the lower respiratory tract (81.10%), blood (6.70%) and abdominal cavity (5.80%). The out-of-hospital and in-hospital infection rates of MDROs were 50.51% and 49.49%, respectively; the out-of-hospital infection rates for MRSA, CRAB, CRPA and CRE were 43.56%, 55.91, 64.44% and 44.58%, respectively. The proportions of MRSA, CRAB, CRPA and CRE infections contracted in the department were 40.98%, 36.27%, 25.56% and 46.62%, respectively. There was a statistically significant difference between comprehensive ICU and specialized ICU wards as sources for CRAB infections (P < 0.001). CONCLUSION: The main source of MDROs in the ICU is not the hospital itself entirely. It is particularly important to strengthen the identification of MDRO sources and implement more effective and accurate infection prevention and control measures.

Rambutan genome revealed gene networks for spine formation and aril development.

Rambutan is a popular tropical fruit known for its exotic appearance, has long flexible spines on shells, extraordinary aril growth, desirable nutrition, and a favorable taste. The genome of an elite rambutan cultivar Baoyan 7 was assembled into 328 Mb in 16 pseudo-chromosomes. Comparative genomics analysis between rambutan and lychee revealed that rambutan chromosomes 8 and 12 are collinear with lychee chromosome 1, which resulted in a chromosome fission event in rambutan (n = 16) or a fusion event in lychee (n = 15) after their divergence from a common ancestor 15.7 million years ago. Root development genes played a crucial role in spine development, such as endoplasmic reticulum pathway genes, jasmonic acid response genes, vascular bundle development genes, and K+ transport genes. Aril development was regulated by D-class genes (STK and SHP1), plant hormone and phenylpropanoid biosynthesis genes, and sugar metabolism genes. The lower rate of male sterility of hermaphroditic flowers appears to be regulated by MYB24. Population genomic analyses revealed genes in selective sweeps during domestication that are related to fruit morphology and environment stress response. These findings enhance our understanding of spine and aril development and provide genomic resources for rambutan improvement.

Analysis of Nosocomial Infection and Risk Factors in Patients with ECMO Treatment.

OBJECTIVE: To investigate the drug resistance of nosocomial infection-related pathogens in patients who underwent extracorporeal membrane oxygenation (ECMO), analyzing the nosocomial infection-related risk factors. METHODS: The medical records of 56 patients who received ECMO support treatment in the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2019 were selected. The nosocomial infection, pathogen distribution and drug resistance, and the influencing factors of nosocomial infection were analyzed. The predictive value of independent risk factors for nosocomial infection after ECMO was analyzed using the receiver operating characteristic (ROC) curve. RESULTS: A total of 56 patients receiving ECMO treatment were included. The nosocomial infection rate was 28.57%, and the prevalence infection rate was 44.64%. Lower respiratory tract infection was the main infection site. Among these infectious patients, 53 strains of pathogens were detected. The results showed that the gram-negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumonia. Moreover, the drug resistance rate of Acinetobacter baumannii to most of the antibiotics was more than 65%, among which the drug resistance rate to carbapenems was 80%. The results of risk factors of nosocomial infection after ECMO were analyzed by univariate analysis, showing that ECMO treatment time, hospitalization time, antibacterial drug use time, ventilator use time, catheter intubation time and central venous intubation time were statistically significant (all p < 0.001). Multivariate analysis identified that ECMO treatment time was an independent risk factor. As showed by ROC curve, ECMO treatment time had a high predictive value for postoperative nosocomial infection. ECMO treatment times of more than 4.5 days were associated with an increased risk of nosocomial infection. CONCLUSION: The nosocomial infection rate after ECMO was relatively high, and the main pathogens are Gram-negative bacteria. The selection of antibiotics should be based on the results of pathogen drug sensitivity.