Clinical application strategies of bacteriophage in treatment of nontuberculous mycobacteriosis / 中华临床感染病杂志

Nontuberculous mycobacteria(NTM) diseases have become an important global public health problem attracting more and more attention because of its increasing morbidity. Mycobacteria show intrinsic and acquired resistance to multiple antibiotics, leading to higher difficulty and longer duration of treatment, and more uncertain prognosis than tuberculosis due to limited therapeutic measures. Bacterial phages are viruses that kill bacteria specifically, phage therapy for bacterial infection has been used for almost one century, now become a hot spot. This article reviews the biological characteristics, gene engineering of mycobacteriophages and its clinical applications; also discusses the existing problems in treatments of NTM with bacteriophages.

Clinical features and diagnostic approaches for abdominal tuberculosis: five-year experience from a non-tuberculosis-designated hospital in China.

BACKGROUND AND PURPOSE: abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB. METHODS: seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB. RESULTS: eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates. CONCLUSIONS: the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings.

Clinical characteristics of the 2019 novel coronavirus Omicron variant infected cases / 中华传染病杂志

Objective:To investigate the clinical characteristics and prognostic factors of 2019 novel coronavirus (2019-nCoV) Omicron variant infected cases.Methods:A total of 987 coronavirus disease 2019 (COVID-19) adult imported cases admitted to Shanghai Public Health Clinical Center, Fudan University from July 1, 2021 to January 6, 2022 were recruited. The cases were divided into Omicron group (193 cases) and non-Omicron group (794 cases) according to the genotype of the virus. The clinical data, imaging examination and laboratory results of two groups were collected and compared. Chi-square test and Mann-Whitney U test were used as statistical methods. Multiple linear regression analysis was used for multiple linear regression analysis. Results:The majority of patients in Omicron group were 18 to 30 years old, accounting for 51.3%(99/193), which was higher than 31.4%(249/794) in non-Omicron group. The difference was statistically significant ( χ2=52.75, P<0.001). The proportion of mild cases in Omicron group was 88.6%(171/193), which was higher than 81.6%(648/794) in non-Omicron group. The difference was statistically significant ( χ2=5.37, P=0.021). Cases with symptoms were more common in Omicron group than those in non-Omicron group (60.1%(116/193) vs 29.1%(231/794)), and the difference was statistically significant ( χ2=65.49, P<0.001), with the main clinical manifestations of sore/itchy throat, fever and cough/expectoration. The proportion of cases with pulmonary computed tomography (CT) imaging manifestations at admission in Omicron group was 13.0%(25/193), which was lower than that in non-Omicron group (215/794, 27.1%). The difference was statistically significant ( χ2=16.83, P<0.001). The proportion of cases with 2019-nCoV IgG positive at admission was 47.7%(92/193) in Omicron group, which was lower than 61.1%(485/794) in non-Omicron group, and the difference was statistically significant ( χ2=11.51, P<0.001). The hospitalization time of Omicron group was 20.0 (16.0, 23.0) d, which was longer than that of non-Omicron group (14.0 (10.0, 22.0) d), and the difference was statistically significant ( Z=-7.42, P<0.001). Multiple linear regression analysis showed that the time of hospitalization of cases with 2019-nCoV IgG positive at admission was shorter, while that of the cases with fever in Omicron group was longer (both P<0.050). Conclusions:The main clinical characteristics of cases with Omicron variant are fever and upper respiratory symptoms. Their pulmonary CT imaging manifestations are less, and the time of hospitalization is slightly longer. The time of hospitalization and the virus clearance time in Omicron variant infected cases with 2019-nCoV IgG positive at admission and not presented with fever are both shorter.

Cross-sectional investigation of nosocomial infection in a tertiary general hospital and construction of a prediction model / 公共卫生与预防医学

Objective To understand the prevalence of nosocomial infection and its potential risk factors through a cross-sectional study, to construct a predictive model of the probability of nosocomial infection, and to provide a basis for nosocomial infection management. Methods The prevalence rate of nosocomial infection and potential risk factors of all inpatients in a tertiary general hospital were investigated on a certain day. The possible risk factors of nosocomial infection were analyzed, and a nomogram prediction model on the probability of nosocomial infection was established. The calibration curve and ROC curve were used to evaluate the predictive efficiency of the model. Results A total of 419 hospitalized patients were investigated, and the prevalence rate of nosocomial infection was 3.58%. The top three nosocomial infections were in ICU, neurosurgery, and cardiac surgery. The top three infection sites were surgical site infections, lower respiratory tract infections, and urinary tract infections. The results of univariate analysis showed that the length of hospital stay, surgery, antimicrobial use and underlying diseases were statistically related to the occurrence of nosocomial infections (all P<0.05). Logistic regression analysis showed that compared with the length of stay (LOS)＜14, the risk of nosocomial infection in patients with long LOS (≥14) was 5.48 (95% CI: 1.68-19.16). The risk of nosocomial infection in patients with two basic diseases was 7.61 times that (95%CI: 1.50-44.79) of patients without underlying diseases. The risk of nosocomial infection in patients with surgery was 4.88 times that of patients without surgery (95%CI: 1.47-19.6). According to the coefficients of the related risk factors calculated by logistic regression, a nomogram model of the occurrence probability of nosocomial infection was established. The C-index of the model was 0.839, and the area under the ROC curve for predictive efficiency was 0.809 (95%CI: 0.740-0.942). Conclusion Nosocomial infection control and management should be strengthened. Individual risk assessment of patients' nosocomial infection should consider about the age, underlying diseases, surgical status, glucocorticoid or immunosuppressive agents, and antimicrobial drug use. It is essential to identify the high-risk groups as soon as possible and take prevention and control measures to reduce the prevalence rate of nosocomial infection.

A descriptive study of the impact of diseases control and prevention on the epidemics dynamics and clinical features of SARS-CoV-2 outbreak in Shanghai, lessons learned for metropolis epidemics prevention

ObjectiveTo describe and evaluate the impact of diseases control and prevention on epidemics dynamics and clinical features of SARS-CoV-2 outbreak in Shanghai. DesignA retrospective descriptive study SettingChina ParticipantsEpidemiology information was collected from publicly accessible database. 265 patients admitted to Shanghai Public Health Center with confirmed COVID-19 were enrolled for clinical features analysis. Main outcome measurePrevention and control measures taken by Shanghai government, epidemiological, demographic, clinical, laboratory and radiology data were collected. Weibull distribution, Chi-square test, Fishers exact test, t test or Mann-Whitney U test were used in statistical analysis. ResultsCOVID-19 transmission rate within Shanghai had reduced over 99% than previous speculated, and the exponential growth has been stopped so far. Epidemic was characterized by the first stage mainly composed of imported cases and the second stage where >50% of cases were local. The incubation period was 6.4 (95% CI 5.3 to 7.6) days and the mean onset-admission interval was 5.5 days (95% CI, 5.1 to 5.9). Median time for COVID-19 progressed to severe diseases were 8.5 days (IQR: 4.8-11.0 days). By February 11th, proportion of patients being mild, moderate, severe and critically ill were 1.9%(5/265), 89.8%(238/265), 3.8%(10/265), 4.5%(12/265), respectively; 47 people in our cohort were discharged, and 1 patient died. ConclusionStrict controlling of the transmission rate at the early stage of an epidemic in metropolis can quickly prohibit the spread of the diseases. Controlling local clusters is the key to prevent outbreaks from imported cases. Most COVID-19 severe cases progressed within 14 days of disease onset. Multiple systemic laboratory abnormalities had been observed before significant respiratory dysfunction.

Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia / 中华传染病杂志

Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t =-4.730, χ 2 =12.930, 5.938 and 4.744, respectively, all P <0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D -dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher ( U =2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P <0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U =1 263.5, t =4.716, U =1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P <0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR )=0.806, 95% CI 0.675-0.961), CRP ( OR =1.016, 95% CI 1.000-1.032), serum myoglobin ( OR =1.010, 95% CI 1.004-1.016), CD3 + T lymphocyte count ( OR =0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR =1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P <0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.

Clinical analysis of risk factors for severe patients with corona virus disease 2019 / 中华传染病杂志

Objective:To analyze the clinical features of patients with corona virus disease 2019 (COVID-19) in Shanghai and the risk factors for disease progression to severe cases.Methods:The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory tests were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using chi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results:Among the 292 patients, there were 21 severe cases with the rate of 7.2%. One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.5±15.7) years old, and 19 (90.5%) were male, 11 (52.4%) had underlying diseases, seven (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, and 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t=-4.730, χ2=12.930, 5.938 and 4.744, respectively, all P<0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin, D-dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum cardiactroponin I (cTn I) in severe patients were all significantly higher ( U=2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 947.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 747.5 and 1 258.0, respectively, all P<0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U=1 263.5, t=4.716, U=1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P<0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR)=0.806, 95% confiderce interval ( CI)0.675-0.961), serum myoglobin ( OR=1.010, 95% CI 1.004-1.016), CRP ( OR=1.016, 95% CI 1.000-1.032), CD3 + T lymphocyte count ( OR=0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR=1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P<0.05). Conclusions:Severe patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.

Microbiological profiles of pathogens causing nosocomial bacteremia in 2011, 2013 and 2016 / 生物工程学报

To dynamically investigate the distribution and antimicrobial resistance profiles of bacteremia pathogens isolated from different regions in China in 2011, 2013 and 2016. Non-repetitive isolates from nosocomial bloodstream infections were retrospectively collected and detected for antimicrobial susceptibility tests (AST) by agar dilution or microbroth dilution methods. Whonet 5.6 was used to analyze the AST data. Among 2 248 isolates, 1 657 (73.7%) were Gram-negative bacilli and 591 (26.3%) were Gram-positive cocci. The top five bacteremia pathogens were as follows, Escherichia coli (32.6%, 733/2 248), Klebsiella pneumoniae (14.5%, 327/2 248), Staphylococcus aureus (10.0%, 225/2 248), Acinetobacter baumannii (8.7%, 196/2 248) and Pseudomonas aeruginosa (6.2%, 140/2 248). Colistin (96.5%, 1 525/1 581, excluding innate resistant organisms), tigecycline (95.6%, 1 375/1 438, excluding innate resistant organisms), ceftazidine/clavulanate acid (89.2%, 1 112 /1 246), amikacin (86.4%, 1 382/1 599) and meropenem (85.7%, 1 376/1 605) showed relatively high susceptibility against Gram-negative bacilli. While tigecycline, teicoplanin and daptomycin (the susceptibility rates were 100.0%), vancomycin and linezolid (the susceptibility rates were 99.7%) demonstrated high susceptibility against Gram-positive cocci. The prevalence of extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriaceae were 50.6% (206/407), 49.8% (136/273) and 38.9% (167/429) in 2011, 2013 and 2016 respectively; carbapenem-non-susceptible Enterobacteriaceae were 2.2% (9/408), 4.0% (16/402) and 3.9% (17/439) in 2011, 2013 and 2016 respectively; The prevalence of multidrug-resistant A. baumannii (MDRA) was 76.4% (55/72) in 2011, 82.7% (43/52) in 2013 and 87.5% (63/72) in 2016, respectively. The prevalence of multidrug-resistant P. aeruginosa (MDRP) was 9.8% (5/51) in 2011, 20.0% (7/35) in 2013 and 13.0% (7/54) in 2016, respectively. The prevalence of methicillin-resistant S. aureus (MRSA) was 51.9% (41/79) in 2011, 29.7% (19/64) in 2013 and 31.7% (26/82) in 2016, respectively. The prevalence of high level gentamicin resistance (HLGR) of Enterococcus faecium and Enterococcus faecalis were 43.2% (48/111) and 40.9% (27/66), respectively. The predominant organism of carbapenem-non-susceptible Enterobacteriaceae was K. pneumoniae with its proportion of 57.1% (24/42). Among 30 tigecycline-non-susceptible Enterobacteriaceae, K. pneumoniae was the most popular organism with 76.7% (23/30). Among 39 colistin-resistant Enterobacteriaceae, E. coli, Enterobacter cloacae and K. pneumoniae were constituted with the percent of 43.6 (17/39), 35.9 (14/39) and 15.4 (6/39), respectively. The Gram-negative bacilli (E. coli and K. pneumoniae were the major organisms) were the major pathogens of nosocomial bacteremia, to which tigecycline, colistin and carbapenems kept with highly in vitro susceptibility. Whereas, among the Gram-positive cocci, S. aureus was the top 1 isolated organism, followed by E. faecium, to which tigecycline, daptomycin, linezolid, vancomycin and teicoplanin kept with highly in vitro susceptibility. Isolation of colistin-resistant Enterobacteriaceae, tigecycline-non-susceptible Enterobacteriaceae, linezolid- or vancomycin-non-susceptible Gram-positive cocci suggests more attention should be paid to these resistant organisms and dynamic surveillance was essential.

Epidemiology and prevention of non-tuberculous mycobacteria infection / 中华临床感染病杂志

Non-tuberculous mycobacteria ( NTM) are organisms ubiquitously existing in the environment, which have been considered as contamination or colonization bacteria .In recent years, more and more evidences suggest that NTM can cause human diseases , resulting in nosocomial infection, even outbreaks.The aim of this article intends to introduce the epidemiology and prevention of NTM infection .

Targeted monitoring on surgical site infection and effect of intervention / 中国感染控制杂志

Objective To explore the incidence of surgical site infection (SSI)and compliance to bundled interven-tion measures,and evaluate the effect of bundled interventions on controlling SSI.Methods From October 2013 to September 2014,three types of surgeries (colorectal surgery,abdominal hysterectomy,and femoral neck repair sur-gery)in 29 hospitals in China were monitored,October 2013 to March 2014 was baseline investigated stage,April 2014 to September 2014 was intervention stage.Results A total of 6 166 episodes of surgeries were monitored,the incidence of SSI was 1 .64%,incidence of SSI following colorectal surgery,abdominal hysterectomy,and femoral neck repair surgery were 4.47%,1 .03%,and 0.21 % respectively.The P 75 time of three types of surgeries were 3,2,and 2 hours respectively.Compared with the baseline stage,the compliance to most intervention measures im-proved after intervention,the largest increase in the compliance to interventions was disinfection with chlorhexidine-containing disinfectant at surgical sites of colorectal surgery (increased by 29.09%),followed by preoperative shower of femoral neck repair surgery (increased by 26.24%),preoperative shower of colorectal surgery(increased by 22.95%),and skin preparation on the day of operation (increased by 20.75%).Incidences of SSI in three types of surgeries were not significantly different before and after intervention(all P >0.05).Conclusion The incidences of SSI are different among different types of surgeries,the compliance to most bundled intervention measures has im-proved to some extent after intervention,but effectiveness of intervention measures needs to be further observed.

Multicenter study on targeted monitoring of surgical site infection and risk factors / 中国感染控制杂志

Objective To investigate the status and risk factors of surgical site infection (SSI)in hospitals in Chi-na,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries (colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery)in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1 .60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hys-terectomy,femoral neck repair surgery,and vascular surgery were 4.47%(74/1 655 ),1 .03%(22/2 139),0.21 %(5/2 372),and 0.00% (0/143 )respectively.The incidences of SSI were different among different regions (χ2 =114.213,P <0.05).The most common SSI was superficial incisional infection,the next was deep incisional infec-tion.The major pathogens causing SSI were Escherichia coli ,Enterococcus spp .,coagulase negative staphylococ-cus ,Staphylococcus aureus ,and Klebsiella pneumoniae .The independent risk factors for SSI were male patients, long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surger-ies.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.

A multicenter prospective monitoring on incidences of ventilator-associated pneumonia in 46 hospitals in China / 中国感染控制杂志

Objective To explore the incidences of ventilator-associated pneumonia (VAP)in intensive care units (ICUs)in China.Methods From October 2013 to September 2014,46 hospitals in 12 provinces and cities were se-lected to participate in the study,all patients admitted to ICUs were included,the incidences of VAP were surveyed and compared with data from the U.S.National Healthcare Safety Network (NHSN).Results A total of 17 358 patients were surveyed,the total patient-days were 176 096 d,the total catheter-days were 91 448 d,813 patients developed VAP,the incidence of VAP was 8.89/1 000 catheter-days,VAP mainly occurred in general ICUs (76.74%);the incidences of VAP were varied with patients in different types of ICUs,ranging from 4.50/1 000 catheter-days to 32.79/ 1 000 catheter-days.Conclusion The incidence of VAP in patients in ICUs at 46 hospitals in China is significantly higher than that reported by NHSN,even higher than the P90 .

Effectiveness of multicenter intervention in hand hygiene compliance among health care workers in intensive care units / 中国感染控制杂志

Objective To evaluate the effect of comprehensive intervention measures on improving hand hygiene (HH)compliance of health care workers(HCWs)in intensive care units (ICUs)by multicenter study.Methods A total of 47 hospitals in 12 provinces and cities were enrolled in the study,from October 2013 to September 2014, HH compliance among HCWs in ICUs was investigated according to World Health Organization HH investigation method,HH compliance rates before and after intervention were compared.Results HH compliance rate of HCWs in ICUs increased from 73.70%(11 155/15 135)before intervention to 78.70%(18 206/23 132)after intervention (χ2 =128.16,P <0.01);except northeast region ,HH compliance of HCWs in the other provinces increased signif-icantly after intervention(all P <0.05);among all departments,HH compliance of HCWs in general ICUs,respira-tory ICUs,emergency ICUs,and surgical ICUs increased significantly(all P <0.05);HH compliance of HCWs of all kinds of occupations increased significantly(all P <0.05);HH compliance rates before touching a patient,before clean/aseptic procedure,after touching a patient,and after touching patient surroundings increased significantly after intervention(all P <0.01 ).Conclusion Comprehensive interventions are helpful for improving HH compliance of HCWs in ICUs. Objective To evaluate the effect of comprehensive intervention measures on improving hand hygiene (HH)compliance of health care workers(HCWs)in intensive care units (ICUs)by multicenter study.Methods A total of 47 hospitals in 12 provinces and cities were enrolled in the study,from October 2013 to September 2014, HH compliance among HCWs in ICUs was investigated according to World Health Organization HH investigation method,HH compliance rates before and after intervention were compared.Results HH compliance rate of HCWs in ICUs increased from 73.70%(11 155/15 135)before intervention to 78.70%(18 206/23 132)after intervention (χ2 =128.16,P <0.01);except northeast region ,HH compliance of HCWs in the other provinces increased signif-icantly after intervention(all P <0.05);among all departments,HH compliance of HCWs in general ICUs,respira-tory ICUs,emergency ICUs,and surgical ICUs increased significantly(all P <0.05);HH compliance of HCWs of all kinds of occupations increased significantly(all P <0.05);HH compliance rates before touching a patient,before clean/aseptic procedure,after touching a patient,and after touching patient surroundings increased significantly after intervention(all P <0.01 ).Conclusion Comprehensive interventions are helpful for improving HH compliance of HCWs in ICUs.

Multicenter study on epidemiology of device-associated infection in neonatal intensive care units / 中国感染控制杂志

Objective To investigate the epidemiological characteristics of device-associated infection (DAI)in neonatal intensive care units(NICUs)of tertiary first-class hospitals in China,and provide scientific evidence for the prevention and control of neonatal DAI.Methods Neonates in NICUs at 17 hospitals of 9 provinces from October 2013 to September 2014 were selected for multicenter study,DAI was surveyed prospectively according to the uni-form diagnostic criteria and methods.Results A total of 12 998 neonates were monitored,the total patient-days were 126 125 d,13 cases of central line-associated bloodstream infection (CLABSI)and 70 cases of ventilator-asso-ciated pneumonia (VAP)occurred,central line utilization rate was 15.56%,incidence of CLABSI was 0.66/1 000 device-days;ventilator utilization rate was 7.67%,incidence of VAP was 7.23/1 000 device-days.Utilization rates of central line and respirator in neonates with body weight ≤ 1 000 g was the highest,which were 61 .06% and 29.91 % respectively;In NICUs with 20-30 beds,utilization rate of central line was the highest(16.67%),and res-pirator was the lowest(4.11 %);of hospitals in different regions,central line and respirator utilization rate in south-west China was the highest.Of different sizes of ICUs,VAP per 1 000 device-days was the lowest in NICUs with 20-30 beds(2.36 ‰).Difference in incidence of CLABSI and VAP per 1 000 device-days in neonates at NICUs of different regions were significantly different;incidence of CLABSI and VAP per 1 000 device-days was highest in southern China(2.68 ‰ and 31 .06‰ respectively),followed by southwest region.Of different quarters,incidence of CLABSI,and VAP per 1 000 device-days were not significantly different(all P >0.05).Conclusion Device utili-zation rate and incidence of DAI in China are both high,and are different in neonates of different birth weight,at different sizes of NICUs,as well as different regions,monitoring should be intensified,prevention and control measures should be implemented according to infection characteristics.

A multicenter intervention study on hand hygiene compliance of health care workers in neonatal intensive care units / 中国感染控制杂志

Objective To improve hand hygiene (HH)compliance of health care workers (HCWs)in neonatal in-tensive care units(NICUs)in China through a series of intervention measures.Methods A multicenter study was conducted,17 tertiary first class hospitals in 9 provinces and cities were selected,HH compliance of HCWs in these hospitals were investigated every month according to HH investigation method of World Health Organization.From October 1 ,2013 to March 31 ,2014 was pre-intervention stage;from April 1 ,2014 to September 30,2014 was post-intervention stage,timely feedback and intensified training were conducted at post-intervention stage.Results HH compliance rates of HCWs before and after intervention were 80.29% and 80.85% respectively,there was no sig-nificant difference (P >0.05).HH compliance rates of HCWs in different sizes of ICUs were significantly different before and after intervention (all P 30 beds were significantly lower than before intervention(P <0.001 );HH compliance rate of cleaners increased from 58.82% before intervention to 68.09% after intervention (P <0.05 );Of different hand hygiene indications,except before clean/aseptic task, compliance to the other HH indications were significantly different between before and after intervention(all P <0.05).Conclusion HH compliance is high among HCWs in NICUs in China,intervention measures,such as inten-sified training and timely feedback have certain influence in compliance to HH among HCWs at different sizes of ICUs,of different occupations,and at different HH indications.

Antimicrobial resistance surveillance of gram-positive cocci isolated from 15 teaching hospitals in China in 2013 / 中华检验医学杂志

Objective Toinvestigateantimicrobialresistanceamonggram-positivecocciinChinain 2013.Methods Retrospectivestudy.FromJune2013toDecember2013,1663consecutiveandnon-repetitive gram-positive cocci were collected from 15 teaching hospitals. The minimal inhibitory concentration ( MIC) of antibacterial agents was determined by agar dilution method. A retrospective study was conducted on rates of resistance to antimicrobial agents. The prevalence of penicillin-resistant Streptococcus pneumoniae ( PRSP) between children and adult patients and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) between elder group and younger adult patients were compared using chi-square test. Results The prevalence of PRSP in children below 3 years old ( 72. 9%, 51/70 ) was higher than adult patients (55. 2%, 106/192) (χ2 =6. 653,P<0. 05). About 94. 9%(261/275) and (92. 7%,255/275) of S. pneumonia were resistant to erythromycin and clindamycin. All S. pneumoniae strains were susceptible to teicoplanin, vancomycin, linezolid, tigecycline and daptomycin. Penicillin still showed very high activity against Streptococcus spp. β-Hemolytic group. More than 60% of Streptococcus spp.β-Hemolytic group were resistant to erythromycin, clindamycin and tetracyclines. The prevalence of MRSA and methicillin-resistant coagulase-negative Staphylococci(MRCoNS) was 39. 7%(229/576) and 80. 6%(224/278), respectively. The MRSA prevalence ranged from 24. 2% to 70. 0% in different regions. About 52. 6%( 100/190 ) of Staphylococcus aureus from respiratory tract specimens, 38. 5%(40/104)of Staphylococcus aureus from blood samples, and 29. 7%(58/195) of Staphylococcus aureus from wound and pus were resistant to methicillin. The prevalence of MRSA in elder group ( 48. 6%, 84/173 ) was higher than that in younger adult patients (35. 7%, 144/403)(χ2 =8. 322,P <0. 05). The susceptibility rates of MRSA to chloramphenicol and trimethoprim/sulfamethoxazole were 86. 4% ( 244/228 ) and 94. 7% ( 237/228 ) , respectively. Susceptibility rates to gentamycin, erythromycin, clindamycin, tetracyclines, rifampicin and quinolones were ranged from 15. 8% to 59. 6%. All Staphylococci isolates were susceptible to teicoplanin, vancomycin, linezolid, daptomycin and tigecycline. All Enterococcus isolates were susceptible to daptomycin and tigecycline. All E. faecalis ( 158/158 ) and 96. 4% ( 133/138 ) of E. faecium were susceptible to teicoplanin. About 98. 0% ( 150/153 ) of E. faecalis and 97. 1% ( 145/138 ) of E. faecium were susceptible to linezoild. About 45. 8% (70/153) of E. faecalis and 60. 9% (84/138) of E. faecium were resistant to gentamycin with a high concentration. The susceptibility of E. faecalis to all the antibiotics tested exceptchloramphenicolandtetracyclinewashigherthanthatofE.faecium.Conclusions Basedon different age groups and regions, the resistance rates of Gram-positive cocci are different. Teicoplanin, vancomycin, tigecycline, daptomycin, linezolid and tedizolid showed very high activity against Gram-positive cocci. (Chin J Lab Med,2015,38:373-381)

An analysis of clinical characteristics, etiologies and prognosis of 218 patients with infective endocarditis / 中华内科杂志

Objective To describe the profile of patients with infective endocarditis (IE) and assess prognostic factors of IE.Methods Clinical and etiology data of 218 patients with IE were collected retrospectively from January 2011 to January 2013.The distribution and antimicrobial susceptibilities of pathogens causing IE were evaluated.Prognostic factors associated with IE were determined by univariate and multivariate regression analysis.Results There were 148 men and 70 women with age of (46.0 ± 14.6)years.Ninety-five (43.6％) of them had heart diseases,including 72 cases (33.0％) of congenital heart disease and 23 cases (10.6％) of chronic rheumatic heart disease.Vegetations were detected by echocardiography in 171 (78.4％) patients.Microorganisms causing IE were identified in 84 cases (38.5％) cases.Streptococcus viridans was the dominant pathogen,accoumed for 63.1％ of all the pathogens,followed by Staphylococcus (13.1％) and Enterococcus (4.8％).Totally 7/11 Streptococcus viridans was susceptible to penicillin,while 100％ susceptible to the third and fourth generation cephalosporins,vancomycin and linezolid.One hundred and eighty cases underwent operations.The in-hospital mortality rate of IE was 3.2％.In univariate regression,health care-associated infection,prosthetic valve,anemia and chest symptoms (distress or pain) were related to the increased risk of mortality in patients with IE,while surgery appeared to be a protective factor.In the logistic regression model,the variables significantly associated with IE prognosis were health care-associated infection (OR =17.03,95％ CI 1.76-164.75,P =0.014) and anemia (Hb ＜ 90 g/L) (OR =13.47,95％ CI 2.46-73.60,P =0.003) and surgery treatment (OR =0.17,95％ CI 0.03-0.97,P =0.047).Conclusions Although Streptococcus viridans is the most common pathogen causing IE,the pathogens of IE become versatile.The antibacterial activity of penicillin against Streptococcus viridans is low.Health care-associated infection and anemia are risk factors of IE prognosis,while surgery treatment is a protective factor of severe IE.

Perioperative antibiotic prophylaxis in colorectal surgery: an investigation of 2 465 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of changes in perioperative antibiotic prophylaxis (PAP) duration in colorectal surgery on surgical site infection (SSI).</p><p><b>METHODS</b>The data on PAP in April and October between 2011 and 2013 was collected from tertiary and secondary hospitals in Shanghai. Prevalence of SSI rates over the same period was compared.</p><p><b>RESULTS</b>A total of 2 465 cases of colorectal surgeries were studied over the three-year period, including 1 784 cases in tertiary hospitals and 681 cases in secondary hospitals. In 940 surgical operations, PAP duration were within 72 hours, accounting for 38.1% of all cases. 48.0% of the operations in 2013 had a PAP within 72 hours, which is significantly higher than that of 20.8% seen in 2011 (χ(2) = 129.986, P = 0.000). In 2013, 53.5% of the all procedures in tertiary hospitals had PAP ≤ 72 hours, compared with 35.5% in secondary hospitals over the same period (χ(2) = 22.714, P = 0.000). Combined uses of nitroimidazoles, with an effect of anti-anaerobic, were used much more commonly in tertiary (76.0%) than in secondary hospitals (41.4%) (χ(2) = 267.820, P = 0.000). The usage of cephamycin were higher in secondary (20.6%) than in tertiary hospitals (4.7%) (χ(2) = 149.865, P = 0.000). According to the investigations by SICC on prevalence of healthcare-associated infections between 2011 and 2013, colorectal surgeries have an average SSI rate of 2.0%. Stratified data showed that the rate of PAP ≤ 72 hours increase from 23.6% in 2011 to 45.8% in 2013 over the same period. However, the SSI rate did not show a significant change (1.9% in 2011, 1.7% in 2013). There was no linearly dependent between the two rates (r = 0.015, P = 0.990).</p><p><b>CONCLUSIONS</b>The proportion of rational PAP of colorectal surgeries in Shanghai has increased. Perioperative antibiotic prophylaxis duration decreased, while SSI rates over the same period did not increase.</p>

Rapid identification of Nontuberculous Mycobacterium using matrix assisted laser desorption/ionization time of flight mass spectrometry / 中华检验医学杂志

Objective The purpose of this study was to compare and develop the method for identification of Non-tuberculous Mycobacteria (NTM) using matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS),and evaluate the feasibility,accuracy and repeatability of MALDI-TOF MS to discriminate NTM.Methods Fifteen clinical strains were collected from January to March in 2012 and 68 environmental strains were retrospectively collected from 2011 to 2012.A protocol for sample pre-treatment and protein extraction was developed and utilized it to identify clinical and environmental isolates.The results from 16 s rRNA sequencing were served as control.Results Method A was more effective in protein extraction.Although all the three methods got the same species result,a total of 83 strains belonging to 10 distinct species grown in Middle brook 7H10 media were analyzed.All members of the NTM were identified accurately at the genus level and 80.7％ (67/83) of strains could be identified at the species level.Six strains were identified at the complex level.81.9％ (68/83) of NTM got high spectral scores.The identification of cultured colony could be completed in 1.5 hours.And it had good reproducibility.Conclusion MALDI-TOF MS can be used as a rapid and accurate method for identification of Mycobacteria in clinical microbiology laboratories,implying its good application prospects.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009.

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia).