Objective To investigate the causes of a suspected outbreak of lower respiratory tract infection (LR-TI)caused by carbapenem-resistant Acinetobacter baumannii (CRAB)in the general intensive care unit(ICU)of a hospital,and provide scientific evidence for effective control of healthcare-associated infection(HAI).Methods Epi-demiological investigation on patients infected with CRAB and on-site monitoring on ICU environmental hygiene from March 4 to 23,2014 were performed,active prevention and control measures were taken.Results A total of 7 patients developed CRAB infection,the total length of stay during epidemic period were 160 days,the infection density of LRTI was 43.75‰(7/160),4 of 5 patients at No.02 bed had CRAB LRTI.Univariate analysis revealed that adopting conventional sputum suction procedure was a risk factor;the qualified rate of bacterial count on the object surfaces was 31 .75% (20/63).CRAB was also isolated from outer frame of suction device of No.02 bed, which had the same antimicrobial pattern as CRAB from 7 patients’sputum.After taking a series of controlling measures,there was no CRAB infection case after March 24,2014,this outbreak was effectively controlled. Conclusion This suspected HAI outbreak may be caused by inadequate disinfection of outer frame of suction device contaminated by CRAB,and horizontally transmitted through manipulation of sputum suction by health care workers.Clean and disinfection of ICU environmental object surfaces is of great importance for preventing HAI.

Objective To analyze the distribution and antimicrobial resistance of Escherichia coli (E.coli)causing infection in a county hospital,and provide basis for clinical treatment of E.coli infection.Methods From 2012 to 2014,all kinds of clinical specimens in a hospital were performed bacterial culture,identification,and antimicrobial susceptibility testing;extended-spectrum β-lactamases (ESBLs )were initially screened by broth microdilution method,and confirmed by disc diffusion method;data were statistically analyzed by WHONET 5.6 and SPSS 19.0 software.Results 271 isolates of E.coli were detected,and mainly isolated from midstream urine (26.94%).The detection rate of ESBLs-producing E.coli was 49.82%,most were isolated from sputum specimens (56.52%), but there was no significant difference in detection rates of ESBLs-producing E.coli isolated from different speci-mens (P >0.05).Antimicrobial susceptibility testing results showed that the resistance rate of E.coli to penicillins was the highest (> 90%),to cefalotin and cefuroxime were both > 75%,susceptibility rates to amikacin and piperacillin/ tazobactam were both high (resistance rates < 10%),carbapenem-resistant strain was not found, resistance rates of ESBLs-producing strains to most antimicrobial agents were significantly higher than non-ESBLs-producing strains.Conclusion E.coli is mainly isolated from midstream urine specimens,antimicrobial resistance of ESBL-producing strains is more serious.

Objective To explore causes of fever in patients after the surgery for congenital heart disease(CHD), and put forward corresponding prevention and control measures.Methods Clinical data of patients undergoing sur-gery for CHD in the department of pediatric surgery of a hospital between January and May 2013 were analyzed ret-rospectively,the whole process of operation and postoperative nursing were observed,environmental hygiene moni-toring was performed at the same time.Results 26 patients all had fever after operation,fever in 21 cases (80.77%)was caused by non-infectious factors,5(19.23%)by infectious factors (ventilator-associated pneumonia in 4 cases,type I incision infection in 1 case).6 cases were absorption fever,20 were abnormal fever,difference in patients’age,duration of invasive manipulation (ventilator,urinary catheter,gastric tube)between two groups of patients were all statistically significant (all P <0.05),patients in the absorption fever group were with older age and short invasive manipulation time.Bacteriological detection rate in 26 patients was 76.92% (n=20),a total of 58 specimens were detected,7 were positive (from sputum specimens of 4 patients),5 isolates (71 .43%)were Pseudomonas aeruginosa .A total of 52 environmental specimens were collected for detection,the qualified rate was 80.77% (n =42).Conclusion Non-infectious factors are the main causes of postoperative fever in patients with CHD,health care workers should enhance the awareness of sterilization,standardize all kinds of medical manipula-tion,and reduce postoperative fever.

Objective To monitor the incidence of catheter-associated infection (CAI)in patients in general inten-sive care unit (ICU),and provide basis for taking proper prevention and control measures.Methods Targeted monitoring method was conducted,incidence of healthcare-associated infection (HAI)among patients receiving urinary catheterization,intravascular catheterization,and tracheal intubation in the general ICU of a tertiary hospital between January 2012 and December 2013 were surveyed.Results A total of 299 ICU patients with catheterization were investigated,the overall hospitalization days were 2 700 days,41 patients developed 48 episodes of HAI, incidence of HAI was 13.71%,case incidence was 16.05%,incidence of HAI per 1 000 catheter days was 15.19‰,37 patients developed 44 episodes of CAI;the other types of HAI were blood stream infection(n=1),skin and soft tissue infection(n = 1 ),antibiotic-associated diarrhea(n = 1 ),and herpes zoster(n = 1 ).Incidence of catheter-associated urinary tract infection (CAUTI),catheter-related bloodstream infection (CRBSI),and ventilator-associated pneumonia (VAP ) per 1 000 catheter days were 2.94‰,2.12‰,and 15.72‰ respectively. Conclusion CAI is the main HAI type in ICU patients with catheterization,and the major is VAP.

Objective To evaluate the occurrence and risk factors for healthcare-associated infection(HAI)in pre-mature infants.Methods The occurrence of HAI among premature infants who were born in a hospital from Janu-ary 2011 to June 2015 and admitted in the neonatal intensive care unit within 24 of birth were investigated prospec-tively,the related risk factors and intervention measures were analyzed.Results 644 premature infants were inves-tigated,32(4.97%)had HAI,the main infection site was lower respiratory tract (n=18,56.25%).34 pathogenic isolates causing HAI were detected, 24 (70.59%) were gram-negative bacteria, the major was Klebsiella pneumoniae (n=14);10 isolates were gram-positive bacteria(29.41%).Logistic regression analysis revealed that small for gestational age, low birth weight, severe amniotic fluid pollution, mechanical ventilation, feeding intolerance,indwelling gastric tube,irrational antimicrobial use,and long length of hospital stay were risk factors for HAI in premature infants (all P < 0.05).Conclusion Risk factors for HAI in premature infants are multiple, targeted interventions,such as shorten the length of hospital stay,reduce unnecessary invasive operation,use antimicrobial rationally,improve the feeding tolerance,are helpful for reducing the risk factors for HAI in premature infants.

Objective To understand antimicrobial resistance and therapeutic efficacy of imipenem/cilastatin and meropenem for treatment of multidrug-resistant Pseudomonas aeruginosa (MDRPA)from patients with mechanical ventilation.Methods From January 2010 to December 2015,78 patients with mechanical ventilation and isolated MDRPA from sputum cultures were selected and divided into imipenem/cilastatin (n=44)and meropenem(n=34) treatment groups,basic condition,time of emergence of drug resistance,and therapeutic efficacy of antimicrobial agents between two groups were compared.Results The basic data of two groups were comparable,before treat-ment by imipenem/cilastatin and meropenem,resistance rates of Pseudomonas aeruginosa (P .aeruginosa )to quinolones,ceftazidime,piperacillin,and amikacin were not significantly different (all P >0.05).After patients received antimicrobial agents for 6 days,difference in antimicrobial resistance between imipenem /cilastatin and meropenem treatment groups were not significantly different (22.73% vs 8.82%,P >0.05).On the 8th,10th,and 12th day of treatment,resistance rates of imipenem treatment group were 40.91%,77.27%,and 97.73%, respectively,which were all higher than meropenem treatment group (17.65%,32.35%,44.12%,respectively,all P <0.05).After the treatment with different antimicrobial agents,the average time for the emergence of resistance in imipenem/cilastatin and meropenem treatment group were 9.0 days and 13.5 days respectively.Therapeutic efficacy between two groups was not significantly different (64.71% vs 74.19%,P =0.41).Conclusion Compared with meropenem,imipenem/cilastatin shows higher risk for the emergence of drug resistance during therapy of P . aeruginosa infection in patients with mechanical ventilation,there is no significant difference in therapeutic efficacy between two groups of patients after 7 days of treatment.

Objective To evaluate clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug-resistant Acinetobacter baumannii (DRAB).Methods 12 patients with DRAB intracranial infection admitted in a department of neurosurgery between January 2014 and April 2015 were analyzed retrospectively,clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of DRAB intracranial infection were evaluated.Results After patients received tigecycline combined with cefoperazone/sulbactam for 12-62 days (39.5 days on average), clinical symptoms and signs (including body temperature,signs of meningeal irritation)of most patients were significantly improved compared with before treat-ment,3 cases were cured,5 were markedly effective,4 abandoned or ineffective(death).The overall effective rate was 66.67%(8/12),mortality was 33.33% (4/12);bacterial clearance rate of cerebrospinal fluid (CSF)was 83.33%(10/12).Causes of death:2 were with failure of brain stem following craniocerebral trauma,1was extensive parenchymal infection,1was recurrence of intracranial infection and formation of brain abscess after withdrawing an-timicrobial agents.No significant adverse reaction occurred during the treatment period.Conclusion On the basis of keeping CSF drainage unobstructed,long course treatment of tigecycline combined with cefoperazone/sulbactam can effectively eliminate DRAB from CSF,and has a good safety.

Objective To explore clinical features and antimicrobial resistance of lower respiratory tract infection (LRTI)with Streptococcus pneumoniae (S .pneumoniae)isolated from children in Nanjing.Methods Clinical data of children with confirmed S .pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively,S .pneumoniae strains were performed antimicrobial susceptibility testing through K-B method and minimum inhibitory concentration (MIC)testing.Results Among 197 children with S .pneumoniae infection,72.59% were <3 years old,63.96% occurred in autumn and winter, 57.87% had elevated leukocyte count,cough and fever were the most common clinical symptoms,complications of digestive and circulatory system were also common.The resistance rates of S .pneumoniae to azithromycin, penicillin,and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin,chloramphenicol,meropenem,ceftriaxone,and ofloxacin were all > 90%,vancomycin was up to 98.98%.Conclusion The percentage of S .pneumoniae LRTI is high in children < 3 years old,most occur in autumn and winter,resistance rates to azithromycin,penicillin,and erythromycin are all high,antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.

Objective To study the intervention effectiveness of intensive training in medical interns’occupational exposure protection.Methods Medical interns in seven colleges and universities in Wuhan between 2011 and 2015 were chosen and divided into control group (675 medical interns in 2011 - 2013,comprehensive training about healthcare-associated infection control was conducted for once before internship )and intervention group (682 medical interns in 2014 - 2015,hospital-department-tutor three steps of intensive training was conducted),the occurrence of occupational exposure and exposure knowledge awareness between two groups were compared. Results The awareness rate of knowledge about occupational exposure protection and the implementation rate of protective measures in intervention group were both higher than control group (all P <0.05).Incidence of occupa-tional exposure in intervention group was lower than control group (21 .70%[n=148]vs 65.33%[n=441 ],χ2 =262.91 ,P <0.01);percentage of interns who conducted active serological virus detection and intensified vaccination of hepatitis B virus were both higher than control group (14.66%[n=100]vs 2.96%[n=20];11 .73%[n=80]vs 2.67%[n=18],respectively).Occupational exposure before and after intervention occurred most frequently when interns were preparing medicine,occupational exposure reporting rate in intervention group was higher than control group (72.97%[108/148]vs 50.11 % [221/441 ],χ2 =52.78,P <0.01 ).Conclusion The intensive training of occupational exposure protection among medical interns can improve the awareness and skills of occupational protec-tion,and reduce the occurrence of occupational exposure.

Objective To investigate the clinical characteristics and risk factors for healthcare-associated infection (HAI)in patients with severe chronic hepatitis B (CHB),and provide theoretical basis for preventing and controlling HAI.Methods Retrospective survey was used to investigate the occurrence of HAI in hospitalized patients with severe CHB in a hospital between January 2012 and January 2015,risk factors for HAI were analyzed. Results A total of 126 patients with severe CHB were investigated,49 patients developed 106 times of HAI, incidence of HAI was 38.89%.The main HAI site was respiratory tract (n=47,44.34%),the next was abdominal cavity (n=34,32.08%).A total of 76 isolates of pathogens were detected,gram-negative bacteria,gram-positive bacteria,and fungi accounted for 53.95%(n =41 ),43.42%(n =33),and 2.63%(n =2)respectively.Risk factors for HAI in patients with severe CHB were patients ’ age ≥ 60 years, length of hospital stay ≥ 30 days, complications,invasive operation,serum albumin < 35 g/L,and white blood cell count (WBC)< 4 × 109/L. Conclusion Incidence of HAI in patients with severe CHB is high,the majority are respiratory tract and abdominal cavity infection,risk factors are old age,long length of hospital stay,invasive operation,hypoalbuminemia,and low WBC count.