Objective To analyze the isolation rates and antimicrobial resistance of Acinetobacter baumannii (AB) from intensive care unit (ICU)between 2010 and 2013,and provide evidence for clinical anti-infective therapy. Methods The isolation and antimicrobial resistance of AB from ICU between 2010 and 2013 were analyzed retro-spectively.Results A total of 1 413 pathogenic strains were isolated,556(39.35%)of which were AB,isolation rates in each year were 39.45%,41 .35%,29.44%,and 40.53% respectively.AB were mainly isolated from lower respiratory tract (75.72%).Antimicrobial susceptibility testing results showed that AB had low resistance rates to cefoperazone/sulbactam(5.85%)and amikacin (17.45%);detection rates of multidrug-resistant and extensively drug-resistant AB increased from 9.63% and 3.70% to 42.50% and 31 .88%,respectively (both P < 0.001 ). Conclusion AB is the common pathogen in ICU,antimicrobial resistance is serious,isolation of multidrug-resistant and extensively drug-resistant AB increased year by year;intensifying the monitoring of drug resistance is helpful for the treat-ment and prevention of AB infection.

Objective To investigate the distribution and antimicrobial resistance of gram-negative bacilli isolated from wound specimens of orthopedic patients,and provide reference for the rational use of antimicrobial agents. Methods 682 isolates of gram-negative bacilli were collected from orthopedic department in a comprehensive hospi-tal between January 2011 and December 2013, antimicrobial susceptibility testing results were analyzed. Results The main gram-negative bacilli isolated from wound specimens of orthopedic patients were Pseudomonas aeruginosa (P .aeruginosa)(16.72%),Escherichia coli (E.coli)(15.40%),and Enterobacter cloacae (E.cloa-cae)(12.76%).The detection rates of extended-spectrum beta-lactamase-producing E.coli and Klebsialla pneu-moniae (K .pneumoniae)were 54.29%(57/105)and 31 .43% (22/70)respectively,and mainly distributed in the trauma orthopedic department,accounting for 49.12% and 45.45% respectively.The susceptibility rates of E.coli, K .pneumoniae ,and E.cloacae to meropenem and imipenem were all 100.00%.The susceptibility rates of E.coli and K .pneumoniae to amikacin,piperacillin-tazobactam and amoxicillin/clavulanic acid were all >80%.Suscepti-bility rate of E.cloacae to most antimicrobial agents were 71 .26% -100.00% except for piperacillin(64.37%). Susceptibility rates of P .aeruginosa to most antimicrobial agents were >85% except for cefepime (78.95%)and aztreonam (65.79%).Conclusion Gram-negative bacilli are the most common pathogens in wound infection of or-thopedics patients.In order to use antimicrobial agents rationally and improve clinical treatment effect,it is impor-tant to realize the distribution of pathogens and antimicrobial resistance.

Objective To observe the clinical efficacy and adverse reactions of tigecycline in treatment of health-care-associated pneumonia (HAP ) caused by extensively drug-resistant Acinetobacter baumannii (XDRAB ). Methods Clinical data of patients who used tigecycline for the treatment of XDRAB HAP in intensive care units of a hospital from March 2013 to June 2014 were retrospectively analyzed.Results XDRAB isolated from 31 patients with HAP were all sensitive to tigecycline,the resistance rates to carbapenems and sulbactams (including cefopera-zone-sulbactam,SCF)were all 100%,17 cases (54.84%)were mixed infection.Combined use rates of tigecycline and SCF were 85.71 %(12/14)in respiratory intensive care unit(RICU)and 47.06%(8/17)in general intensive care unit(GICU).Of 31 patients,the cure rate,effective rate,bacterial clearance rate,and antimicrobial adverse reac-tion rate were 29.03%,45.16%,61 .29%,and 16.13% respectively,no serious adverse drug reactions occurred. In RICU group and GICU group,the cure rates were 42.86% and 17.65% respectively,effective rates were 71 .43% and 23.53% respectively,and bacterial clearance rates were 78.57 % and 47.06% respectively,difference in effective rate between two groups was significant (P <0.05).Among patients receiving combination of tigecycline and SCF as well as not receiving combined SCF,the cure rates were 35.00% and 18.18% respectively,effective rates were 60.00% and 18.18% respectively,and bacterial clearance rates were 65.00% and 54.55% respectively, difference in effective rate between two groups was significant (P <0.05).Conclusion Tigecycline has a good clini-cal efficacy and little adverse reaction in treating XDRAB HAP;tigecycline combined with SCF is a good choice.

Objective To evaluate the effect of controlling cost by introducing hand hygiene products with lower price on promoting hand hygiene compliance.Methods The application status and cost of hand hygiene products in 2012 was as pre-intervention group,2013 was as post-intervention group.Effective and lower price hand hygiene products were introduced in 2013,consumption and cost of hand hygiene products before and after the intervention was compared.Results Consumption of hand hygiene products per patient-day before and after the intervention was significantly different ([10.56±16.46]mL vs [13.79 ± 16.93 ]mL,Z=4.14,P <0.01 );cost of hand hygiene products per patient-day before and after the intervention was not significantly different ([1 .23 ±2.07]yuan vs [0.92±0.59]yuan,P >0.05).Conclusion Introduction of hand hygiene products with lower price in this hospital can improve hand hygiene compliance to certain degree without increasing the cost of hand hygiene.

Objective To understand the infection caused by multidrug-resistant organisms(MDROs)in a neurological in-tensive care unit (Neuro-ICU),and evaluate the effect of comprehensive intervention measures.Methods Targeted monito-ring on MDROs among patients who hospitalized in a Neuro-ICU for >48 hours between March and December 2011 was implemented,comprehensive intervention measures were taken,MDRO infection before and after intervention was com-pared.Results A total of 932 patients were monitored,72 (7.73%)developed MDRO healthcare-associated infection (HAI);the top five MDROs were Acinetobacter baumannii ,Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Staphylo-coccus aureus ,and Escherichia coli .The main infection site of MDRO infection was lower respiratory tract,followed by urinary tract and bloodstream.Detection rates of MDROs before and after intervention were 11.70%(n=55)and 3.68%(n=17)respectively(χ2 =16.675,P <0.001).Conclusion Patients in Neuro-ICU are prone to develop MDRO infection, comprehensive intervention measures can reduce the incidence of HAI.

Objective To evaluate the correlation between occupational exposure and work intensity of health care workers(HCWs)in an infectious diseases hospital for 5 consecutive years,and provide reference for occupational precaution.Methods Occupational exposures cases reported between January 2010 and December 2014 were ana-lyzed retrospectively,occupation types,exposure routes,and exposure sources were analyzed.Results A total of 228 cases of occupational exposure were reported,nurses and doctors were the major exposure population(75.44%and 19.30% respectively);occupational exposure mainly occurred during the infusion process(52.19%);hepatitis B was the main exposure source (71 .05%),followed by human immunodeficiency virus (10.09%).The Pearson correlation coefficient between the occupational exposure rate of doctors and the ratio of doctors to patients was-0.849 (P <0.05),and for nurses,the correlation coefficient was -0.823 (P <0.05 ).Conclusion Nurses are high risk population of occupational exposures,occupational exposure is most likely to occur during transfusion process,occupational exposure of doctors and nurses has a strong correlation with the work intensity.

Objective To investigate the status of tuberculosis (TB)infection among health care workers (HC-Ws)in an infectious diseases hospital,and explore the risk and influencing factors of TB infection.Methods All HCWs in an infectious diseases hospital were surveyed through questionnaire and purified protein derivative (PPD) testing.Results Incidence of TB infection among all HCWs in this hospital was 48.18%.There was no significant difference in TB infection among HCWs in different departments(P >0.05).TB infection among HCWs of different working seniority,different ages,and different job titles were all significantly different (all P <0.05).Risk factors for TB infection were education level,job title,living condition,and working time in TB clinics or wards,OR (95%CI )were 1 .70(1 .03-2.80),1 .95(1 .10-3.45),1 .84(1 .03-3.28),and 2.38(1 .40-4.04)respectively;personal protection was a protective factor for TB infection (OR,0.92 [95% CI ,0.85 - 0.99]).Conclusion HCWs in in-fectious diseases hospital are at high risk of TB infection,they should improve their self-protection consciousness, and take protective measures as early as possible.

Objective To evaluate the effect of comprehensive intervention on perioperative antimicrobial prophy-laxis in clean incision surgery in a hospital.Methods From 2011 ,clean incision surgery cases were performed com-prehensive intervention,antimicrobial use in 2011 -2013 were compared.Results A total of 5 945 cases of clean in-cision surgeries were investigated between 2011 and 2013,3 827 cases (64.37%)received prophylactic use of anti-microbial agents.Prophylactic antimicrobial usage rates in 2011 -2013 were 84.95%,69.99%,and 52.97% re-spectively(χ2 =380.94,P <0.001);the correct rates of medication time were 50.97%,79.99%,and 98.95% re-spectively(χ2 =827.02,P <0.001 );the percentages of prophylactic antimicrobial use ≤24 hours were 24.91 %, 39.96%,and 64.95% respectively(χ2 =422.55,P <0.001 );additional antimicrobial usage rates during surgery were 50.00%,60.00%,and 80.00% respectively(χ2 =59.47,P <0.001 ).Conclusion The implementation of comprehensive intervention measures can standardize antimicrobial use,reduce prophylactic antimicrobial usage rate,improve the correct rate of medication time,shorten the duration of antimicrobial use,and implement addition-al use of antimicrobial agents during surgery.

Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective To investigate the nationwide prevalence of healthcare-associated infection (HAI),and es-tablish the related indexes of HAI.Methods A cross-sectional survey was conducted through combination of bed-side investigation and medical record reviewing,the prevalence of HAI in hospitals of National HAI Surveillance System and other hospitals voluntarily participated in the survey were investigated according to unified survey pro-gram.Results A total of 1 008 584 patients in 1 766 hospitals participated in the survey,26 972 cases of HAI occurred, prevalence rate of HAI was 2.67%,antimicrobial usage rate was 35.01%.Difference in prevalence rates of HAI and anti-microbial usage rates among hospitals with different number of beds were both significant (χ2 =1 599.21,3 458.40,re-spectively,both P <0.01).The main infection sites were lower respiratory tract (47.53%),urinary tract (11.56%)and surgical site(10.41%).A total of 13 784 pathogenic strains were isolated,the top five pathogens were Pseudomonas aeruginosa ,Escherichia coli ,Klebsiella pneumoniae ,Acinetobacter baumannii ,and Staphylococcus aureus .Prevalence rate of HAI and prophylactic antimicrobial usage rate in patients receiving operation of class Ⅰincision were 1.01% and 27.99% respectively,difference in prophylactic antimicrobial usage rates in patients receiving operation of classⅠincision at hospitals with different number of beds were significant (χ2 =400.34,P <0.01 );among patients receiving antimicrobial prophylaxis,percentage of specimens sending for bacterial detection was 45.89%,difference in bacterial detection rates in hospitals with different number of beds were significant (χ2 =9 189.90,P <0.01).Hospital with more than 900 beds had the highest prevalence rate of HAI(3.36%),lowest usage rate of antimicrobial agents(32.35%),and highest bacterial de-tection rate(56.03%).Conclusion Multiple indexes of this cross-sectional survey revealed that HAI management in China has achieved remarkable results;meanwhile,calculation of the percentile distribution of each index is convenient for self-evaluation for HAI-related work in each hospital.