Isolation and drug resistance phenotype distribution of carbapenem-resistant Klebsiella pneumoniae in a hospital / 中国感染控制杂志

Objective To analyze drug resistance phenotypes and clinical distribution characteristics of clinically isolated carbapenem-resistant Klebsiella pneumoniae(CRKP),and provide evidence for rational use of antimicrobial agents and control of healthcare-associated infection(HAI). Methods CRKP isolated from inpatients in a hospital in 2013-2015 were collected,sources of specimens and homology of antimicrobial susceptibility of pathogens were analyzed. Results Of 949 non-repetitive strains of Klebsiella pneumoniae,75 (7.90% )were CRKP strains. The detection rates of CRKP from 2013 to 2015 were 1.35% ,7.77% ,and 17.04% respectively,which showed an up-ward trend year by year,difference was statistically significant(P<0.01). The main infection sites of CRKP were respiratory tract and urinary tract,CRKP mainly distributed in intensive care unit(ICU),geriatrics and emergency departments. Susceptibility rates of CRKP to amikacin and trimethoprim/sulfamethoxazole were 57.33% and 48. 00% respectively. 22 (29.33% )cases of CRKP infection were community-acquired and 53 (70.67% )were health-care-associated infection. 18 (24.00% )cases died among 75 CRKP infected patients. According to drug resistance phenotype analysis,there were 5 clones of CRKP strains,mainly distributed in ICU,geriatrics and emergency de-partments.Conclusion The proportion of CRKP infection is increasing year by year,clinical monitoring on CRKP should be strengthened,intensive infection control measures should be tarken,so as to prevent and control the spread and prevalence of CRKP.

Implementation of active screening for preventing and controlling the spread of multidrug-resistant organisms in intensive care unit / 中国感染控制杂志

Objective To implement active screening measures for patients in intensive care unit (ICU),early de-tect patients with multidrug-resistant organism (MDRO)colonization,implement contact isolation measures,pre-vent and control MDRO cross transmission.Methods The nasal and rectal swabs of 240 patients who were admit-ted to ICU from September 2012 to May 2013 were performed bacterial culture,patients with colonization of methi-cillin-resistant Staphylococcus aureus (MRSA),extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli ,and ESBLs-producing Klebsiella pneumoniae were conducted contact isolation.Clinically isolated MDROs from ICU patients in September 2011-August 2012 (before active screening)and September 2012-August 2013 (after active screening)were collected and performed antimicrobial resistance analysis.Results Of 240 patients, nasal swabs screening test showed that there were 56(23.33%)patients who were colonized with MRSA,including 22(39.29%)were colonized at the admission to ICU and 34(60.71%)during the ICU stay.Rectal swabs screening test showed that there were 105(43.75%)patients who were colonized with ESBLs-producing Escherichia coli and Klebsiella pneumoniae ,72(68.57%)were colonized at the admission to ICU,and 33(31.43%)were colonized dur-ing the period of ICU stay.The incidence density of MDROs before and after implementing active screening were 28.56‰ and 13.71‰ respectively,difference was significant (P < 0.05;RR,2.08 [95%CI ,1.582 - 2.743]). Conclusion MDRO colonization rate is high among ICU inpatients,implementation of comprehensive prevention and control measures against MDROs based on active screening can reduce the spread of MDROs in ICU.

The effect of ventilator circuit change frequency on ventilator-associated pneumonia incidence / 中国综合临床

Objective To explore the effect of ventilator circuit change frequency on the incidence of ventilator-associated pneumonia (VAP). Methods Patients receiving mechanical ventilation in the ICU,Department of Emergency, Respiratory Department and Department of Neurosurgery from March 2008 to September 2010 were randomized into two groups. For these two groups ,the ventilator circuit was changed once or twice a week. The recorded parameters included the clinical symptoms and signs of the ventilated patients. Samples at different parts of the circuit were collected for microbiological detection. The data were analyzed statistically. Results The incidence of VAP was 28. 30% ( 13/53 ) in twice-a-week group and 35.84%( 19/53 ) in once-a-week group. There was no significant difference between the two groups. The rates for positive microbiological detection in the circuit were 48. 16% and 44. 49% for once-a-week and twice-a-week group,respectively. No significant difference was observed ( P ＞ 0.05 ). Moreover, there was no significant difference in terms of the microbiology positivity between different parts of the circuit(P ＞ 0. 05 ). Gram-negative bacteria were the main pathogen of VAP with Acinetobacter baumannii ranking at the top. Conclusion Frequency of Ventilator circuit change does not influence the incidence of VAP. We suggest that the frequency for ventilator circuit change should be once a week. At the same time, the nurse staff should be trained for specific technology and the incidence of hospital infection should be controlled at multiple rings of the chain.

Multidrug-resistant Bacteria Infection in our Hospital:Investigation and Control Analysis / 中华医院感染学杂志

OBJECTIVE To promote the multidrug-resistant bacteria infection control. METHODS Questionnaire investigated has been used to understand what degree the healthcare workers have known about controlling multidrug-resistant bacteria infection,what difficulties they would be met when they had put prevention and control measures in practice. RESULTS Total 13 questions of prevention and control multidrug-resistant bacteria nosocomial infection,the rate of right answer was 26.9% and the rate of partial right answer was 38.4%.The healthcare workers had lacked of professional knowledge about the prevention and control of multidrug-resistant bacteria nosocomial infection. The major difficulties were crowded wards,short of beds,incomprehension of patients and their families,cost of articles for disinfection and isolation when the medical staff put isolation measures into practice. CONCLUSIONS All prevention and control measures againt multidrug-resistant bacteria infection should be put into practice. We should strengthen training of healthcare workers about professional knowledge,gain support of leaders,and enhance communication between medical staff with patients and supervision.

Transdifferentiating of adult human pancreatic stem cells into islet cells / 中华外科杂志

<p><b>OBJECTIVE</b>To understand and improve the transdifferentiation of pancreatic stem cells into islet cells through isolation, cultivation and transdifferentiation of adult human pancreatic duct cells.</p><p><b>METHODS</b>A portion of adult human pancreas was digested with collagenase, followed by incontinuous density gradient to separate islets from the acinar and ductal tissue. Duct epithelial cells were cultivated in CMRL1066 and then in serum-free DMEM/F12 medium with the addition of growth factors for 27 days. Samples were taken at different time points for light and electron microscopic examination and for immunocytochemical study with antibodies against transdifferentiation gene PDX-1 and protein CK-19. Amylase and insulin contents in the medium were assayed.</p><p><b>RESULTS</b>A large number of duct epithelial cells were harvested after the isolation of islets. Some duct epithelial cells were PDX-1 and CK-19 positive at day one and duct epithelial cells proliferated and expanded rapidly and then transdifferentiated into stem cells and finally 3D islets. 760 islets were harvested from each gram of pancreatic tissue on day 27.</p><p><b>CONCLUSIONS</b>Adult pancreatic duct cells are potential stem cells and could be transdifferentiated into islet cells in vitro under appropriate conditions.</p>