Objective To analyze the risk factors for healthcare-associated pneumonia (HAP) in patients with orthopedic injury,provide the basis for making prevention and control measures.Methods HAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively,risk factors were analyzed by univariate and multivariate logistic regression methods.Results A total of 2 578 patients with orthopedic injury were investigated,92 patients developed HAI,incidence of HAP was 3.57％.107 strains of pathogens were detected,the major were Klebsiella pneumoniae (n =22,20.56％),Escherichia coli (n =14,13.08％),and Acinetobacter baumannii (n =13,12.15％).Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days,smoking history≥3 years,bedridden ≥7 days,associated with underlying diseases,complications,indwelling catheter≥7 days,surgical operation,mechanical ventilation,admitted to intensive care unit,open injury,blood sugar≥11 mmol/L,plasma albumin＜30 g/ L,hemoglobin concentration＜90 g/L,and use of glucocorticoid≥4 days (all P＜0.05).Multivariate logistic regression analysis showed that smoking,bedridden,surgery,mechanical ventilation,glucocorticoid use,and anaemia were independent risk factors for HAP in patients with orthopedic injury.Conclusion The occurrence of HAP in patients with orthopedic injury is related with multiple factors,the major are surgical operation,mechanical ventilation,glucocorticoid use,long term smoking,bedridden,and anaemia.

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.

OBJECTIVE:To provide reference for rational drug use and hospital infection control. METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan. 2011-Oct. 2017. Drug sensitivity test was conducted by using MIC. The situation of AmpC enzyme production was confirmed by three dimensional test, and that of ESBLs-producing stain was detected with double-disk synergy test. RESULTS:There were 546 strains of AmpC enzyme-producing E. cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80% of non-sputum specimen (546/11 375)and 38.97% of E. cloacae(546/1 401). Top 3 non-sputum samples in the list of detection rate were wound secretion (27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%), neurosurgery department(18.68%)and general surgery department(16.67%). Resistance rate of AmpC enzyme-producing E. cloacae to most commonly used antibiotics was higher than 40%. There was statistical significance in resistant rate of the bacteria to ceftriaxone, cefotaxime, gentamicin, nitrofurantoin, levofloxacin, piperacillin/tazobactam, cefoperazone, ceftazidime,cefepime,tobramycin and minocycline among different years (P<0.05). The resistant rate to imipenem and meropenem was lower than 2%. Among 546 strains of AmpC enzyme-producing E. cloacae,68 strains of ESBLs were detected,and detection rates were 5.77%,6.06%,8.70%,10.26%,13.79%,17.35%,18.75% during 2011-2017. CONCLUSIONS:AmpC enzyme-producing E. cloacae are mainly isolated from samples as wound secretion and midstream urine,and mainly come from ICU and neurosurgery department. The drug resistance of the bacteria is severe,and drug resistance of the bacteria to antibiotics as β-lactams and quinolones is increased significantly. The detection rate of ESBLs-producing strain increases year by year. The bacteria are sensitive to carbapenems antibiotics,which can be regarded as first choice. It is necessary to strengthen drug resistance and enzyme production monitoring of AmpC enzyme-producing E. cloacae,select antibiotics combined with results of drug sensitivity test so as to prevent or delay the rapid increase of its resistance rate.

Objective To analyze the characteristics of concurrent pattern elements of the patients with phlegm or non-phlegm pattern in metabolic syndrome, explore the correlation between different disease locations as well as complicated diseases and physicochemical parameters in patients with metabolic syndrome, and to provide a theoretical basis for the early detection, diagnosis and treatment of the disease. Methods The 2005 International Diabetes Federation diagnostic criteria and pattern element differentiation method were used to select 334 patients of metabolic syndrome with phlegm pattern and 288 patients of metabolic syndrome with non-phlegm pattern into this study. Physical and chemical parameters and TCM four diagnostic data were entered and analyzed with SPSS 20.0 to explore characteristics of concurrent pattern elements of phlegm and non-phlegm patterns in patients with metabolic syndrome,and to explore the correlation between different locations as well as complicated diseases and physicochemical parameters in patients of metabolic syndrome. Results 1.Disease locations of liver, spleen, kidney, lung,gallbladder, stomach distributed in phlegm group were more frequent than those in non-phlegm group;the percentage of patients with dampness, fever, qi stagnation, blood stasis, qi deficiency, yin deficiency,yang deficiency and blood deficiency were higher than those in non-phlegm group. 2.In male patients with phlegm pattern, the frequency of disease location in the liver was lower than that in the spleen and stomach,while the female patients had opposite distribution. The age of the liver and spleen groups were less than the age in the kidney group among patients with phlegm pattern. 3. In phlegm-pattern patients,the frequency of blood deficiency pattern among male patients was lower than that of qi deficiency,yin deficiency and yang deficiency patterns, while the frequency of females was higher than those of the three groups. The levels of uric acid (UA) and creatinine (Cr) in yang-deficiency pattern group were higher than those in blood deficiency pattern group. Cr levels in yin deficiency pattern group were also higher than those in blood deficiency pattern group. Conclusions Disease locations of phlegm pattern group in metabolic syndrome were: liver, spleen, kidney, lung, gallbladder, stomach and miscellaneous diseases were dampness,heat,qi stagnation, blood stasis, qi deficiency, yin deficiency, yang deficiency, and blood deficiency; Non-phlegm pattern group presented no concurrent pattern element characteristics. Disease locations were in the stomach in the male while they were changed to the liver in the female. Concurrent pattern elements was blood deficiency in patients of phlegm pattern in metabolic syndrome. In addition, the order of disease location of metabolic syndrome patients with phlegm pattern was spleen,liver and kidney. There was a correlation between yin-yang disharmony and levels of UA and Cr.