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Risk factors for healthcare-associated infection in patients after extracorporeal membrane oxygenation procedure

Weiying ZENG ; Guosui XIAO ; Zhenfeng ZHONG ; Lijuan RONG

Chinese Journal of Infection Control.2014;(4):212-214. doi:10.3969/j.issn.1671-9638.2014.04.005

Objective To realize the incidence of healthcare-associated infection(HAI)in patients after receiving extracorporeal membrane oxygenation(ECMO)procedure,and to evaluate the related factors for HAI.Methods Clinical data of patients receiving ECMO from January 2003 to December 2012 were collected and analyzed retro-spectively.Results Of 43 patients receiving ECMO,15 (34.88% )developed 24 times(55.81% )of HAI. The main HAI site was lower respiratory tract(n= 12,50.00% ),followed by blood stream(n= 6,25.00% ),skin and soft tis-sue(n= 5,20.83% ).A total of 28 isolates of pathogens were detected,gram-negative bacilli were 19(67.86% )iso-lates,gram-positive cocci 7(25.00% ),and fungi 2(7.14% );pathogens were mainly isolated from specimens of sputum(n= 12,42.86% ),blood (n= 9,32.14% )and wound secretion(n= 6,21 .43% ). The incidence of postopera-tive HAI in ECMO patients was related with patients’age,duration of ECMO,complication,mechanical ventila-tion,tracheal intubation or tracheotomy,and indwelling urinary catheter.Conclusion HAI in patients receiving EC-MO is high,hospital should take corresponding prevention and control measures targeting to the related risk factors of infection,so as to reduce the incidence of HAI after the ECMO.

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Difference in drug resistance of pathogens causing early-and late-onset ventilator-associated pneumonia in an intensive care unit

Shuke JIANG ; Biaofeng LUO ; Rongming LI ; Xiaoyan CHEN ; Chunfeng LI ; Yongnan XU ; Lin LI ; Zhenkai TAO

Chinese Journal of Infection Control.2014;(4):208-211. doi:10.3969/j.issn.1671-9638.2014.04.004

Objective To study the incidence of ventilator-associated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).Methods The occurrence of VAP in hospitalized patients with mechan-ical ventilation>48 hours between January 2011 and December 2012 were investigated,species and antimicrobial re-sistance of pathogens causing early onset-VAP (E-VAP,mechanical ventilation≤4 d)and late-onset VAP(L-VAP, mechanical ventilation>4 d)were compared.Results A total of 1 76 patients were investigated,incidence of VAP was 44.32% (78 cases);With the prolongation of mechical ventilation,incidence of VAP increased gradually (χ2=52.561,P<0.001).The incidence of L-VAP was significantly higher than E-VAP (58.33% [70/120]vs 14.29%[8/56])(χ2= 30.02,P<0.001).A total of 178 pathogens were isolated,gram-negative bacteria,gram-positive bac-teria and fungi were 104(58.43% ),46(25.84% ),and 28(15.73% )isolates respectively;97(54.49% )multidrug-resistance/pandrug resistance organisms (MDRO)were isolated. MDRO isolation rate in L-VAP patients was high-er than E-VAP patients([58.86% ,n= 93]vs [20.00% ,n= 4]),resistance rate of major pathogens causing L-VAP was significantly higher than E-VAP patients(allP<0.05).Fungi infection only occurred in L-VAP patients,the total antimicrobial resistance rate was 12.14% .Conclusion The prolongation of mechanical ventilation can increase the incidence of VAP,and resistance rate of pathogen in L-VAP is high.

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Current status and management strategies on central sterile supply depart-ments inmedical institutes

Ping CHEN ; Ding LIU

Chinese Journal of Infection Control.2014;(4):203-207. doi:10.3969/j.issn.1671-9638.2014.04.003

Objective To realize the current status of central sterile supply departments(CSSDs)in hospitals,and provide the basis for making improvement measures.Methods Field investigation was adopted to study the resource distribution,personnel structure,and the quality of medical instrument cleaning in 78 hospitals in Chongqing.Re-sults Qualified results of 78 hospitals was 24.36% (19/78),basically qualified rate 52.56% (41/78),unqualified rate 23.08% (18/78);inspection results of different types of hospitals were significantly different(Hc= 16.643,P=0.002),qualified hospitals mainly concentrated on city- and county-level hospitals.Unqualified rate of CSSD con-struction area was 78.21% (n= 61),unqualified rate of personal allocation was 75.64% (n= 59),concentrated man-agement of operating rooms and CSSDs was 52.56% (n= 41),mainly concentrated on city- and county-level hospi-tals;decentralized management accounted for 47.44% (n= 37),58(74.36% )hospitals used repeated cleaning stain-less steel tables for receiving,50% didn’t install automated cleaning machine and drying cabinet,42.31% (33/78) performed manual cleaning,40(51.28% )didn’t equip with water treatment system;12(15.38% )hospitals used patched or worn clothing for packing,47 didn’t equip with hard metal container,37(47.44% )had no heat sealing machine,21(26.92% )had no detection equipment for cleaning quality,41(52.56% )had no low temperature sterili-zation instruments;52(66.67% )hospitals performed biological monitoring on high pressure steam sterilizer.Conclu-sion Clean and disinfection equipments in CSSDs in city- and county-level hospitals are well-appointed,procedures of clean and disinfection are standard,and can achieve the standard of clean quality;while hospitals affiliated to fac-tories and private hospitals are not well-appointed,procedures of clean and disinfection are not standard. Construc-tion of CSSD should be standard,so as to ensure the effectiveness of clean,disinfection and sterilization of surgical instruments.

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Role of procalcitonin in early diagnosis of hand,foot and mouth disease with bacterial infection

Jinling YANG ; Longfeng CHEN ; Xiaofeng QIN

Chinese Journal of Infection Control.2014;(5):277-280. doi:10.3969/j.issn.1671-9638.2014.05.006

Objective To evaluate the role of procalcitonin (PCT)in the early diagnosis for hand,foot and mouth disease (HFMD)with bacterial infection.Methods Clinical data of 234 HFMD children who were hospitalized be-tween January and July 2012 were analyzed retrospectively,according to discharge diagnosis,data were divided into simple viral infection group (n=178)and viral associated with bacterial infection group (n=56),and data of 20 healthy children were selected as the control group.Serum PCT,C-reactive protein (CRP)and peripheral white blood cell (WBC)count were compared.Results There was significant difference in the level of PCT,CRP and WBC among three groups (F=381.94,24.18,and 26.46,respectively,all P<0.05).The positive rate of PCT,CRP and WBC among three groups was significantly different(χ2=178.25,38.98,and 71.21,all P<0.05),PCT,CRP and WBC in bacterial infection group(92.86%[52/56],85.71%[48/56],and 87.50%[49/56]respectively)were significantly higher than those of simple viral infection group (3.93%[7/178],62.36%[111/178],and 30.90%[55/178]respectively)and healthy control group (5.00%[1/20],10.00%[2/20],and 5.00%[1/20]respectively).The sensitivity rate of PCT,CRP and WBC was 92.86%,85.71%,and 87.50% respectively,specificity rate was 95.00%,90.00%,and 95.00% respectively.Conclusion The level of PCT has important value for the early diagno-sis of HFMD with bacterial infection,and its accuracy rate and sensitivity are better than CRP and WBC levels.

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Application of plasma procalcitonin and D-dimer measurements in estima-ting the prognosis of patients with sepsis

Jing CHEN

Chinese Journal of Infection Control.2014;(5):274-276. doi:10.3969/j.issn.1671-9638.2014.05.005

Objective To evaluate the clinical value of plasma procalcitonin and D-dimer measurements in estima-ting the prognosis of patients with sepsis.Methods According to prognosis,68 patients with sepsis were divided in-to survival group and death group,levels of procalcitonin and D-dimer,and acute physiology and chronic health eval-uation II (APACHE II)of two groups of patients were compared,predictive value of above markers in estimating the prognosis of patients with sepsis were evaluated.Results Of 68 patients with sepsis,28 survived and 40 died, mortality was 58.82%.There were significant differences in levels of procalcitonin and D-dimer,as well as APACHE II between two groups(both P<0.05),death group were all higher than survival group.Procalcitonin and D-dimer level were positively correlated with APACHE II score(P<0.05).Conclusion Procalcitonin,D-dimer level and APACHE II score can be used to evaluate condition of patients with sepsis as well as the prognosis of dis-ease.

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Correlation between serum procalcitonin concentration and systemic in-flammatory response syndrome score in patients with bacterial bloodstream infection

Hao LI ; Sue YUAN ; Juan FAN

Chinese Journal of Infection Control.2014;(5):271-273. doi:10.3969/j.issn.1671-9638.2014.05.004

Objective To evaluate the correlation between serum procalcitonin concentration and systemic inflam-matory response syndrome (SIRS)score in patients with bacterial bloodstream infection.Methods In January-De-cember,2012,96 patients with bacterial bloodstream infection in a hospital were selected as trial group,and these patients were divided into three groups(group A,B and C)according to SIRS score;84 patients without bacterial in-fection was as control group,PCT concentration of all patients were detected,and the correlation between PCT con-centration and SIRS score was analyzed.Results Among 96 patients with bacterial bloodstream infection,7 (7.29%)died (4 were in group B and 3 in group C);there was no death case in control group.PCT concentration in control group,group A,B and C of trial group were (0.28±0.09)ng/mL,(0.63±0.13)ng/mL,(3.68±1.01)ng/mL,and(7.45±1.53)ng/mL,respectively,the difference between each group was significant(P<0.01).Pairwise comparison of four groups showed statistical difference (P<0.001).Spearman correlation analysis on PCT concen-tration and SIRS score was conducted,correlation coefficient r=0.874(P<0.001)suggested positive correlation be-tween serum PCT concentration and SIRS score.Conclusion PCT concentration in patients with bacterial blood-stream infection and SIRS score is positively correlated,PCT concentration and SIRS score can be used as two mark-ers for assessing the extent and prognosis of bacterial bloodstream infection.

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Distribution and antimicrobial resistance of pathogens isolated from hospi-talized patients with bloodstream infections

Shengyuan ZHAO ; Shuzhen XIAO ; Lizhong HAN ; Chenrong MI ; Yuxing NI

Chinese Journal of Infection Control.2014;(5):266-270. doi:10.3969/j.issn.1671-9638.2014.05.003

Objective To investigate the species and drug resistance of pathogens causing bloodstream infections in hospitalized patients,and provide scientific evidence for antimicrobial use and control of healthcare-associated blood-stream infection.Methods From January 1 to December 31,2012,16 428 blood specimens were performed blood culture,pathogens were isolated and performed antimicrobial susceptibility testing.Results Of 16 428 blood speci-mens from 5 546 patients,384 (6.92%)were positive for blood culture,398 pathogenic isolates were detected,of which gram-positive bacteria,gram-negative bacteria,and fungi accounted for 23.62% (n=94),68.34% (n=272),and 8.04% (n=32)respectively,positive rate of blood culture were highest in 61-80 age group(8.26%), the top five departments of positive rate of blood culture were departments of burn,traditional Chinese medicine, cardiac intensive care unit,transplantation and traumatology;gram-positive cocci were highly susceptible to vanco-mycin,teicoplanin and linezolid,one Enterococcus faecium strain was found to be resistant to vancomycin;Among gram-negative bacilli,Enterobacteriaceae were highly susceptible to amikacin and carbapenems;drug resistance rates of Acinetobacterbaumannii and Pseudomonasaeruginosa to carbapenems was 70.97% and 35.90% respective-ly.Conclusion Gram-negative bacteria are the major pathogens causing bloodstream infection,positive rate of blood culture of elderly people is high.It is necessary to conduct regular surveillance on distribution and drug resistance of pathogens.

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Role of immunoglobulin in treating chronic obstructive pulmonary disease with fungal infection

Jianrong ZHU ; Xiaolian WAN

Chinese Journal of Infection Control.2014;(5):281-283. doi:10.3969/j.issn.1671-9638.2014.05.007

Objective To explore the clinical effect of intravenous immunoglobulin(IVIG)on chronic obstructive pulmonary disease(COPD)and fungal infection.Methods Seventy-two COPD patients with fungal infection were randomly and equally divided into conventional and intervention group.Patients in conventional group were treated with common schedule for COPD plus antifungal agents;patients in intervention group received 1 0 g/d IVIG besides routine therapy.Length of hospital stay and prognosis were recorded,and therapeutic effectiveness were evaluated. Results The effectiveness rate of intervention group was significantly higher than that of conventional group ([88.89%,32/36]vs [66.67%,24/36]);the average length of hospital stay was significantly shorter than conven-tional group ([12.62±7.51]d vs [20.81±6.92]d),and mortality was lower than conventional group ([5.56%, 2/36]vs [22.22%,8/36]),the differences were statistically significant (P<0.05).Conclusion IVIG for treating COPD with invasive pulmonary fungal infection can improve therapeutic efficacy,shorten length of hospital stay and decrease mortality rate.

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Spatio-temporal distribution characteristics of syphilis in Mainland China, 2005-20 1 1

Xiaodan YI ; Baosen ZHOU

Chinese Journal of Infection Control.2014;(5):257-262. doi:10.3969/j.issn.1671-9638.2014.05.001

Objective To investigate the spatio-temporal distribution characteristics of syphilis epidemic in Main-land China in 2005-2011.Methods Geographic information system was established based on the data of syphilis epidemic and demographic information from online reporting system of 3 1 provinces,municipalities and autonomous regions of Mainland China from 2005 to 2011,global indication of spatial autocorrelation(GISA),local indication of spatial autocorrelation (LISA),and spatial-temporal cluster analysis were conducted by GeoDa 0.95i and SaTScan 9.1 .1 software,high risk areas of spatial-temporal distribution of syphilis were determined.Results The number of syphilis in Mainland China in 2005-2011 were 1 841 217 cases,annual incidence was 20.07/100 000,suggesting a sign of obvious cluster distribution.Except 2011,GISA coefficient Moran’s I were statistically different.Accord-ing to LISA analysis,Jiangsu,Shanghai,Zhejiang and Fujian lay in high-high region in 2005-2009,Chongqing lay in high-low region in 2006-2008,and in 2011,no area was found in high-high region.Spatio-temporal cluster anal-ysis showed that the most likely cluster was in Shanghai and Zhejiang (2009-2011);the secondary cluster distribu-ted in five areas,including Guangdong,Guangxi and Hainan (2009-2011),Xinjiang (2009-2011),Liaoning and Jilin (2010-2011),Gansu,Ningxia,Shaanxi,Sichuan,Chongqing,Shanxi and Inner Mongolia (2011),Beijing and Tianjin (2008-2010).Conclusion Significant spatio-temporal cluster pattern is found for the distribution of syphilis in mainland China,which can be meaningful for pertinent control.

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Economic loss of healthcare-associated infection in hospitalized children with acute respiratory infection

Xiufen ZHENG ; Yaru XU ; Huirong ZHAO ; Hongliang DENG ; Yan WANG ; Yao YU ; Jing LI

Chinese Journal of Infection Control.2014;(7):428-430. doi:10.3969/j.issn.1671-9638.2014.07.014

Objective To study direct economic loss of healthcare-associated infection (HAI)in hospitalized children with acute respiratory infection (ARI),and the influence in satisfaction degree of children’relatives.Methods Clinical data of 1 039 children with ARI in a pediatrics ward between April 1,2012 to March 31,2013 were analyzed retrospective-ly.50 patients with HAI were in case group and 50 patients without HAI were in control group.The difference in medical cost and the degree of satisfaction of children’s relatives were compared between two groups.Results Medical cost of pa-tients in case group was significantly higher than control group([P 25 - P 75 :￥3 095.54 - ￥4 779.48]vs [P 25 -P 75 :￥1 744.14-￥2 382.07],Z =5.89,P <0.01).The expenses in medicine,laboratory examination,diagnosis and treatment,and nursing in case group were all higher than control group,there were significant differences between two groups(all P <0.01 );Hospitalization day of case group was significantly longer than control group ([P 25 -P 75 :9 d-15 d]vs[P 25 -P 75 :6 d-8 d],Z =5.79,P <0.01 ).Satisfaction degree of patients’relatives in case group was significantly lower than control group (Z =8.22,P <0.01).Conclusion HAI occurred in ARI children can increase medical cost,prolong length of hospital stay and decrease satisfaction degree of patients’relatives.

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