Objective To investigate the change in distribution and antimicrobial resistance of pathogens from blood culture of children,and provide a basis for treatment of bloodstream infection.Methods Pathogens isolated from blood culture of hospitalized children between January 2009 and December 2013 were divided into group 2009-2011 and 2012-2013.Distribution and antimicrobial susceptibility of pathogens were analyzed.Results From 2009 to 2013,a total of 48 455 blood specimens were taken for culture,2 730 pathogenic bacteria were isolated,positive rate was 5.63%.The positive rate of blood culture decreased year-by-year (χ2 =415.30,P <0.01 ).Of 2 730 iso-lates of pathogenic bacteria,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 80.37% (n =2 194),18.68%(n=510),and 0.95%(n=26)respectively.The difference between two groups of pathogenic bacte-ria was significant(χ2 =180.334,P <0.001).Susceptibility rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were all 100%,resistance rates of coagulase-negative Staphylococcus and Staphylococcus aureus to cip-rofloxacin,compound sulfamethoxazole and tetracycline all decreased.Susceptibility rates of gram-negative bacilli to imipenem,meropenem and amikacin were all≥97.50%,susceptibility rate of Klebsiella pneumoniae to levofloxacin was 100%;Of cephalosporins,Escherichia coli and Klebsiella pneumoniae had high resistance except ceftazidime and cefepime.Conclusion Distribution of pathogens from blood culture of children in 2009-2013 changed signifi-cantly,pathogens have high resistance to commonly used antimicrobial agents,more attention should be paid to the monitor of pathogens from blood culture and pathogenic antimicrobial resistance.

Objective To evaluate the clinical significance of serum procalcitonin (PCT)in early diagnosis of pul-monary tuberculosis (PTB)complicated with pulmonary infection.Methods Clinical data of active PTB patients admitted to a hospital between August and December 2013 were collected,patients were divided into bacterial infec-tion group(n=104),fungal infection group(n=37)and control group (n=95)according to whether patients were associated with bacterial infection,fungal infection,and without infection,serum PCT concentrations in three groups were compared,receiver operating characteristic (ROC)curve analysis was conducted.Results The median PCT concentrations in bacterial infection and fungal infection group was 0.44ng/mL and 0.30ng/mL respectively, which was significantly higher than 0.16ng/mL of control group(Z =9.49,3.51 respectively,both P <0.001 ).The area under curve (AUC)was 0.89(0.84-0.93)and 0.69(0.61 -0.77)respectively;cut-off point was 0.31 ng/mL and 0.27 ng/mL respectively;sensitivity was 79.81%(70.57%-86.80%)and 59.46%(42.19%-74.80%)respectively;specificity was 83.16%(73.79%-89.78%)and 73.68%(63.48%-81.95%)respectively.Conclusion PCT level is a valuable predictor for early diagnosis of PTB complicated with pulmonary infection,and can provide reference for the rational use of antimicrobial agents.

Objective To investigate the economic losses in kidney transplant patients with healthcare-associated lower respiratory tract infection(LRTI).Methods All transplant patients in a hospital from 2008 to 2012 were in-vestigated,patients with LRTI were in infection group(n=45),and patients without LRTI were in control group(n=266),hospitalization expenses and hospitalization days between two groups were compared.Results A total of 383 kidney transplant patients were included in the study,the incidence of LRTI was 11 .75% (n=45),median ex-pense of infection group and control group was ￥79 291 .82 and ￥72 185.14 respectively,the difference was not statistically significant (P >0.05).The largest increased expense in patients with LRTI was medicine (increased by￥5 429.82),medicine and examination expense in infection group were significantly higher than control group (￥39 123.17 vs ￥33 693.35;￥702.52 vs ￥593.73;P <0.05 ).The median hospitalization days in infection group and control group was 28.38 days and 21 .47 days respectively,there was significant difference between two groups(P <0.05 ).Conclusion Kidney transplant patients with LRTI suffer from a heavy financial burden,and their hospitalization days are prolonged,so measures should be taken to prevent the occurrence of LRTI and save limited medical resources.

Objective To realize the incidence of healthcare-associated infection (HAI),the rate of invasive procedure and related infection rate,use of antimicrobial agents and distribution of pathogens in gereral intensive care units (GICUs) of hospitals in China.Methods HAI cross-sectional investigation data of GICUs reported to China HAI Surveillance Net-work were summarized and analyzed.Results Of 1 313 hospitals,621(47.30%)had GICUs;a total of 5 887 patients were surveyed,1 634 patients developed 1 962 times of infection,HAI prevalence rate and case rate was 27.76% and 33.33%respectively.The main infection sites were lower respiratory tract(70.39%),urinary tract (12.79%)and blood(2.86%). The application rate of urinary catheter,arteriovenous catheter and ventilator was 53.52%(n=3 151),37.05%(n=2 181) and 35.62%(n=2 097)respectively,and related prevalence of urinary tract infection,pneumonia and blood stream infection was 4.67%,20.41%,and 0.60%,respectively,which accounting for 58.57%,30.99%,and 23.21 % of urinary tract infection,pneumonia and blood stream infection respectively,the overall prevalence of above invasive procedure-re-lated infection accounted for 29.97%(588/1 962)of the overall HAI prevalence.A total of 1 795 isolated pathogens causing HAI were detected,the top three were Pseudomonas aeruginosa (20.78%),Acinetobacter baumannii(17.99%)and Klebsiella pneumoniae (11 .64%).The usage rate of antimicrobial agents was 71 .58%(n=4 214), rate of specimens delivered for detection was up to 75.27%(2 553/3 392).Conclusion Prevalence and antimicrobial use in patients in GICUs are all high,all kinds of invasive procedure are frequent,30% of HAI are related to inva-sive procedure;infection caused by non-fermentative bacteria is serious,pathogen detection is well performed.

Objective To investigate healthcare-associated infection(HAI)prevalence and antimicrobial use in a hospital.Methods HAI prevalence rate,antimicrobial use and pathogen detection in all inpatients on August 21 , 2013 were investigated with cross-sectional survey method.Results A total of 2 238 inpatients were investigated, 104 patients developed 126 times of HAI,HAI prevalence rate and case rate was 4.65% and 5.63% respectively;the top four sites for HAI were lower respiratory tract (28.57%),upper respiratory tract(18.25%),urinary tract (7.94%)and gastrointestinal tract(4.76%).Rate of specimens delivered for detection was 91 .35%(95/104),the main specimen was sputum (26.32%),followed by blood (25.26%)and urine (10.53%).Antimicrobial usage rate was 24.58%,therapeutic,prophylactic plus therapeutic,and prophylactic use accounted for 36.55%,45.09%, and 18.36% respectively;the usage rate of single,combination of 2,and 3 antimicrobial agents accounted for 75.82%,20.91 % and 3.27% respectively.Risk factors of HAI were age (<15 or >60 years),all kinds of inva-sive procedures (tracheotomy,mechanical ventilation,urinary catheterization,arteriovenous intubation,hemodialy-sis),and anti-tumor chemotherapy.Conclusion Survey on HIA prevalence helps to know the occurrence of HAI and usage of antimicrobial agents,as well as risk factors and high-risk departments of the occurrence of HAI,it also provides basis for subsequent targeted monitor on HAI.

Objective To investigate risk factors for healthcare-associated infection(HAI)in patients with craniocerebral operation,and provide reference for the prevention and control of HAI.Methods A total of 4 246 cases of craniocerebral surgery in a neurosurgery department from January 2010 to December 2012 were enrolled in the study,the risk fac-tors for HAI were analyzed.Results Of 4 246 cases of craniocerebral surgery,393 patients developed 446 times of post-operative HAI,HAI incidence rate was 9.26%,case infection rate was 10.50%,which were higher than inci-dence (2.02%)and case infection rate (3.02%)of HAI of all hospital during the same period,the difference was statistically significant (χ2 =811 .06,629.30,respectively,P <0.001).The major infection site was central nervous system (56.50%),followed by respiratory system (27.36%).Unconditional univariate logistic regression analysis showed that sex,age,community-acquired infection,primary disease,operative time,length of stay in intensive care unit (ICU)before infection,the number of surgery,invasive procedures and nasogastric tube,the difference was statistically significant (all P <0.05 ).Multivariate logistic regression analysis showed that sex,elderly pa-tients,congenital brain diseases,stay in ICU>7 d,antimicrobial use >7 d,central venous and urinary tract cathe-terization,invasive ventilator were risk factors for HAI in patients with craniocerebral operation.Conclusion The incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures accord-ing to risk factors should be strengthened to reduce the incidence of HAI.

Objective To investigate transmission routes of healthcare-associated infection(HAI)caused by methi-cillin-resistant Staphylococcus aureus (MRSA),and make effective measures for preventing and controlling the oc-currence and epidemic of HAI caused by multidrug-resistance bacteria.Methods From February 24 to March 29, 2012,12 MRSA-infected patients were performed epidemiological study,these patients underwent bronchoscopy be-cause of tracheal stenosis,strains were identified by amplifying the sequences of 16S rRNA ,femA and mecA with real-time quantitative polymerase chain reaction (PCR),homology analysis of strains were performed by Spa geno-typing.Results All 12 MRSA-infected patients were susceptible to multidrug-resistance bacterial infection,5 cases of MRSA infection occurred during this hospitalization.Detection of specimens from health care workers and envi-ronment were all negative;Spa gene of all 12 MRSA isolates was type t 030 ,which was the main epidemic strain in Asia;Spa gene of Staphylococcus aureus isolated from nurses’noses was type t1425 .Conclusion The assumption of MRSA spread among health care workers aren’t supported by the epidemiological investigation results,genotypes of 12 MRSA isolates are identical,but the result of gene typing can’t be as the evidence of homology of infection ;patients at high risk for MRSA infection should be screened as early as possible,early contact isolation should be performed,so as to prevent and control the occurrence of HAI.

Objective To investigate the activities associated with nurses’occupational exposure to bloodborne pathogens and the source patients’infection status during blood collection process,so as to provide a basis for developing occupational exposure prevention strategies.Methods Data about occupational exposure to bloodborne pathogens during blood collection process in a hospital from August 2011 to September 2013 were monitored.Results A total of 89 times of bloodborne ex-posure occurred among HCWs,including 75 times of arterial blood collection and 14 venous blood collection.The top three procedures of occupational exposures were rebounding of needles after needles were pulled out (28.09%,n=25),concen-trated cleaning up of rubbish at the end of blood collection (20.22%,n=18),and touching blood and body fluids by skin and mucous membrane (14.61%,n=13).48.31% (n=43)source patients infected with at least hepatitis B virus,hepati-tis C virus ,hepatitis E virus,Treponema pallidum,and human immunodeficiency virus ,51.69%(n=46)source patients were not infected ,after proper handling,none of nurses were infected during blood collection .Conclusion Developing safe blood-withdraw needle,putting sharp instrument into sharp instrument container,wearing gloves,and intensifying training of standard and occupational precaution are important strategies for the reducing of the occurrence of bloodborne exposure of clinical nurses during blood collection process .

Objective To evaluate diagnostic value and clinical significance of procalcitonin (PCT)in infection in intensive care unit (ICU)patients.Methods 96 ICU patients in a hospital between September 2011 and March 2012 were selected for study,levels of patients’PCT,high-sensitivity C-reactive protein (HsCRP)and white blood cell (WBC)count were detected,statistical analysis were conducted.Results Compared with non-bacteria infected patients,serum PCT and HsCRP levels in all bacteria infected patients increased,the difference were significant (Z=-6.102;-3.918,both P <0.05 );WBC count was not significantly different(Z =0.212.P >0.05).PCT sensi-tivity,specificity,positive predictive value,and negative predictive value for diagnosing infection was 82.35%, 67.86%,86.15%,and 61 .29% respectively;receiver operating characteristic (ROC)curve of PCT,HsCRP,and WBC was 0.898,0.755,and 0.581 respectively.Conclusion There are higher sensitivity and specificity of PCT to predict infection,which is helpful for early detection of infection in critically ill patients.

Objective To evaluate the influence of the placement of instant hand disinfectant in compliance and qualified rate of hand hygiene of clinicians.Methods Hand hygiene compliance of clinicians in departments of gyne-cology,obstetrics,and general surgery were observed after the placement of instant hand disinfectant at the door-way of wards,hand specimens were taken to check hand hygiene effectiveness.Results Before and after placement of instant hand disinfectant at the doorway of wards of above departments,hand hygiene behaviors of 300 person-times were observed.Hand hygiene compliance rate among clinicians in department of gynecology,obstetrics,and general surgery increased from 32.33% to 74.33%,33.67% to 85.67%,and 26.33% to 64.00%,respectively(all P <0.001).Each department selected 98 hand hygiene specimens,the qualified rate was 98.98%,100.00% and 94.90% respectively.Conclusion The placement of instant hand disinfectant at the doorway of each ward can effec-tively improve clinicians’hand hygiene compliance and hand hygiene effectiveness.