Objective To investigate colonization of multidrug-resistant organisms (MDROs)in neonatal intensive care unit (NICU)newborns on admission.Methods From April to November 2013,293 newborns who admitted to NICU of a hospital were screened for methicillin-resistant Staphylococcus aureus (MRSA)by nasal and throat swabs and for extended-spectrumβ-lactamases (ESBLs)bacteria and vancomycin-resistant Enterococcus (VRE)by anal swabs.Results Of 293 newborns,61 were detected MDROs (20.82%).The positive rate of MDROs screening in newborns aged <3 days(5.92%)was lower than those aged <3-6 days(37.74%)and 7-28 days (43.66%), the difference was significant (P =0.000).The major colonized MDROs were ESBLs-producing bacteria(83.60%), the major colonized site was anus(88.52%).Conclusion Neonatal anus and stool are important sources of MDROs in NICU;more attention should be paid to colonization screening for MDROs by anal swabs in newborns aged >3 days,and appropriate isolation measures should be taken for positive screening patients to prevent the transmission of MDROs.

Objective To investigate the healthcare-associated infection(HAI) status, common infection sites, and antimicrobial use in a county hospital in 2011-2015.Methods With combination of bedside survey and case history reviewing, HAI among all hospitalized patients at 0:00-24:00 on April 26, 2011, April 25, 2012, May 14, 2013, September 9, 2014, and August 12, 2015 were surveyed, survey data were analyzed by software SPSS17.0.Results A total of 5 165 patients participated in 5 surveys of HAI prevalence rate, 132 patients had 138 cases of HAI, prevalence rate and case prevalence rate were 2.56％ and 2.67％ respectively.Intensive care unit had the highest average HAI prevalence rate(22.58％).Lower respiratory tract was the main HAI site (58.70％), followed by urinary tract (12.32％), upper respiratory tract (10.14％), and skin soft tissue(5.07％).A total of 45 strains of pathogens were isolated, mainly gram-negative bacteria (n=30, 66.67％).The total usage rate of antimicrobial agents was 45.27％, in 5 prevalence surveys were 61.48％, 43.89％, 37.81％, 39.43％, and 44.79％ respectively.The main purpose of antimicrobial use was therapy (including therapy + prevention), accounting for 78.27％;monotherapy accounted for 81.27％.Conclusion Through prevalence rate survey for 5 consecutive years, HAI management departments can be more comprehensively understand HAI in key departments, key patients, key sites of HAI, and antimicrobial use in this hospital, and provide basis for the formulation and implementation of HAI prevention and control measures according to the actual situation of the hospital.

Objective To investigate the therapy and influencing factors for prognosis of ventilator-associated pneumonia(VAP) caused by multidrug-resistant organisms(MDROs).Methods 169 patients with VAP who were admitted to a hospital between January 2012 and December 2013 were included in analysis, 125 were in MDRO infection group and 44 in non-MDRO infection group.MDRO infection group was subdivided into MDR-A group(n=78, resistant to selected antimicrobial agents) and MDR-B group (n=47, sensitive to at least one kind of selected antimicrobial agent).Antimicrobial choice and prognosis between each group were analyzed and compared.Results 242 strains of pathogenic bacteria were isolated from airway secretion of VAP patients, 173(71.49％) were MDROs.The major pathogens causing VAP were Klebsiella spp.(n=66), Pseudomonas aeruginosa(n=64), Acinetobacter spp.(n=60), Staphylococcus aureus(n=27), and Escherichia coli (n=17), the percentages of MDROs of above pathogens were 68.18％, 50.00％, 91.67％, 88.89％, and 76.47％ respectively.The prognosis of MDRO infection group was poorer than that of non-MDRO infection group, MDR-A group had the worst prognosis(P<0.001).Persistent fever, leukocytosis, and progress of pulmonary inflammation in VAP patients suggested poor prognosis(all P<0.001);antimicrobial use in patients with effective therapy was higher than those in a worsened condition before onset, at the beginning of onset, and after culture of specimens(all P<0.001), while coma, early-onset VAP and multiple bacterial infection had no prognostic significance in patients with VAP(all P>0.05).Conclusion There is high incidence of MDRO infection in patients with VAP, effective antimicrobial therapy can improve the prognosis.

Objective To investigate the effectiveness of training at morning shift meeting in improving healthcare-associated infection(HAI) prevention and control among health care workers(HCWs) in newly established hospital departments.Methods On July 11-22, 2016, HAI management full-time personnel performed training for HCWs about HAI prevention and control at morning shift meeting of 8 newly established clinical departments and 1 laboratory, the questionnaire survey was conducted before, immediately after, and 3 months after training, training effectiveness was evaluated.Results A total of 239 HCWs were required to receive training, including 85 doctors (35.6％), 150 nurses (62.8％), and 4 technicians (1.7％).The knowledge of HAI prevention and control that most HCWs wanted to know was occupational exposure and occupational precaution(85.6％);most HCWs wanted to obtain knowledge of HAI through training in their respective department by HAI management full-time personnel(87.1％).Total awareness rates of HAI knowledge before, immediately after, and 3 months after training were 45.1％, 96.7％, and 83.9％ respectively, difference was significant(P<0.001);comparison among groups showed that HCWs'' awareness in influencing factors of HAI, hand hygiene opportunity, isolation measures, and medical waste classification 3 months after training was significantly lower than immediately after training(all P<0.001);the average scores of HAI prevention and control knowledge among HCWs immediately after and 3 months after training were both higher than before training(P<0.001);average score of HAI prevention and control knowledge among HCWs 3 months after training was lower than that of immediately after training(P<0.001).Conclusion The training at morning shift meeting of clinical departments can improve the awareness of HAI prevention and control knowledge among HCWs.

Objective To understand the epidemiological and clinical features of Brucella infection outbreak, provide basis for the timely diagnosis, prevention and control of brucellosis.Methods Epidemiological history, clinical symptoms and signs, auxiliary examination, and therapeutic efficacy of 8 patients with brucellosis and admitted to a hospital between December 2015 and April 2016 were analyzed retrospectively.Results All 8 patients had touched stray sheep and participated in the butchering, all were male patients, with the average age of 50 years;all patients had sweating, fatigue and other symptoms, 7 had a fever, 6 were with lumbago, 3 with muscular soreness, and 2 had a cough.Brucella was cultivated from blood specimens of 8 patients, the specific antibody titers ranged from 1:200 to 1:1 600.All patients recovered from illness through 6-week treatment with rifampin plus levofloxacin, without recurrence after 6-month observation.Conclusion Clinical manifestations of brucellosis are atypical, history of epidemiology should be carefully inquired, combined with etiology, early diagnosis and early treatment can be performed.

Melioidosis is a endemic infectious disease caused by Burkholderia pseudomallei, and is considered one of the major causes of fatal pneumonia and sepsis.This paper reports diagnosis and treatment course of one case pulmonary melioidosis, and reviews the related literatures, so to improve clinical workers'' understanding towards melioidosis, avoid misdiagnosis and missed diagnosis.

Objective To understand the distribution and drug resistance of pathogens from patients with anastomotic fistula infection after esophageal cancer surgery, and provide basis for clinical diagnosis and treatment.Methods Patients were admitted to a hospital due to anastomotic fistula after esophageal cancer surgery between January 2012 and December 2015, microbial culture and antimicrobial susceptibility testing results of patients were retrospectively analyzed.Results 1 986 patients underwent radical resection of esophageal cancer within 4 years, 148 of whom developed anastomotic fistula, 104 (70.27％) were with positive microbial culture.A total of 197 pathogenic strains were isolated, 52(26.40％)and 145 (73.60％)strains were isolated from intrathoracic anastomotic fistula and cervical anastomotic fistula respectively;127 (64.47％)strains were gram-negative bacteria, the major were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii, 62(31.47％) strains were gram-positive bacteria, the major were Staphylococcus aureus, Enterococcus spp., and Streptococcus viridans, 8 strains (4.06％) were fungi.49(47.12％) cases were with mixed pathogenic infection.The resistance rates of gram-negative bacteria to imipenem were 17.86％-47.62％, to polymyxin B was 0, resistance rates of Pseudomonas aeruginosa to other antimicrobial agents were all<50％, Klebsiella pneumoniae to piperacillin and aztreonam were both>70％, Acinetobacter baumannii to most antimicrobial agents were all>50.00％;resistance rates of gram-positive bacteria to clindamycin and tetracycline were both>50.00％, to linezolid, vancomycin, and teicoplanin were all 0, resistance rates of Staphylococcus aureus to penicillin, oxacillin, and ciprofloxacin were all>60％,resistance rate of Enterococcus spp.to quinupristin/dalfopristin was 100.00％.Conclusion Postoperative anastomotic fistula combined with infection can affect the prognosis of patients after esophageal cancer surgery, regular monitoring on distribution and drug resistance of pathogens can provide the basis for initial empirical treatment, and is conducive to the early treatment and rational use of antimicrobial agents.

Objective To realize the clinical characteristics of fungemia in premature infants.Methods Clinical characteristics of fungemia in premature infants in the intensive care unit of a children''s hospital between January 2011 and December 2015 were analyzed retrospectively, general condition of premature infants, laboratory-related indicators, and antimicrobial susceptibility testing results were compared.Results From January 2011 to December 2015, 42 premature infants with confirmed fungemia were treated in this hospital, 22 (52.38％) of whom were with fungemia caused by Candida albicans(C.albicans), 13 (30.95％) by Candida parapsilosis (C.parapsilosis), 3 by Candida krusei (C.krusei), and 4 by other fungi.Patients were grouped according to the main pathogens causing infection: C.parapsilosis group and C.albicans group.Maternal genitourinary tract infection rate and incidence of fungal meningitis in C.albicans group were both higher than C.parapsilosis group(27.27％ vs 7.69％, 27.27％ vs 0.00％ respectively), peripherally inserted central catheter (PICC) rate in C.albicans group was lower than that in C.parapsilosis group(22.73％ vs 69.23％), platelet count in C.parapsilosis group was lower than C.albicans group, differences were all statistically significant (all P<0.05).Conclusion The major fungi causing fungemia in premature infants were C.parapsilosis and C.albicans, maternal reproductive system infection during pregnancy can easily lead to candidemia, premature infants with candidemia are more vulnerable to developing fungal meningitis;PICC is more likely to lead to C.parapsilosis fungemia, and platelet decline is more obvious.

Objective To investigate the current status of nurses'' needlestick injuries during venous blood sampling, evaluate effective prevention strategies.Methods A stratified cluster sampling method was used to investigate clinical nurses in China by questionnaire, contents of questionnaire included the general information of nurses, training and management on venous blood sampling among nursing staff, adherence to wearing gloves before blood sampling, the occurrence of needlestick injuries during the process of venous blood sampling in the past year and so on.Results A total of 2 861 questionnaires were distributed, and 2 575 valid questionnaires were recovered.93.17％ of the investigated nurses had participated in the training of venous blood sampling regularly;87.15％ received regular check of venous blood sampling;before venous blood sampling, only 72.74％ knew whether the patient had bloodborne infectious disease;only 61.01％ wore gloves during blood sampling.Incidence of needlestick injuries during venous blood sampling was 20.78％ in the past year.There was no significant differences in the incidence of needlestick injuries when using 3 different types of needles(Pearson x2=1.649, P=0.438).48.21％ of needlestick injuries occurred during disposing medical waste.Conclusion The training and management on nurses'' venous blood sampling is better in China, but incidence of needlestick injuries is still high.It is necessary to formulate safety operation regulations of venous blood sampling, standardize the operation procedures and specify the contents of training, so as to correct nurses'' unsafe behavior during venous blood sampling.

Objective To understand the occurrence of healthcare-associated infection(HAI) in intensive care units (ICUs) in secondary and above hospitals in a province, and provide basis for HAI management.Methods HAI management quality control center in a province performed targeted monitoring on HAI in ICUs in secondary and above hospitals in a province from July 1, 2010 to June 30, 2015.Results ICUs in 176 hospitals were monitored, the incidence of HAI in ICUs for 6 consecutive years was 7.23％, case incidence of HAI was 9.72％;incidence of HAI showed a decreased trend in 6 years(P<0.001).The adjusted rate of HAI per 1 000 patient days in the general hospital ICUs was higher than that of special hospital ICUs (4.30‰ vs 3.53‰).Incidence of HAI in surgical ICUs and general ICUs were both relatively higher, adjusted rates of HAI per 1 000 patient days were 4.79‰ and 4.21‰ respectively.Respiratory tract, urinary tract, and bloodstream infection were major HAI in ICUs, accounting for 68.64％, 14.45％, and 10.09％ respectively, the utilization rates of central venous catheter, ventilator, and urinary catheter were 49.86％, 39.16％, and 81.95％ respectively, incidence of three catheter-associated infection were 1.74‰, 13.77‰, and 2.08‰ respectively, incidence of three catheter-associated infection decreased year by year (P<0.001).The utilization rates of ventilator, central venous catheter, and urinary catheter in different ICUs were not correlated with the incidence of infection(all P>0.05).A total of 36 223 strains of pathogens were isolated, the top 6 isolated pathogens were Acinetobacter baumannii(22.77％), Klebsiella pneumoniae (11.96％), Pseudomonas aeruginosa(11.94％), Staphylococcus aureus (8.08％), Candida albicans (5.63％), and Escherichia coli(5.55％).The isolation rates of carbapenem-resistant Klebsiella pneumoniae showed a increased tendency for 6 years(P<0.05).Conclusion Continuous targeted monitoring on HAI in ICUs, regular analysis on risk factors for HAI, and timely implementation of intervention measures can effectively decrease the incidence of HAI.