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A retrospective study of ganciclovir in the therapy of adult infectious mononucleosis

Chinese Journal of Infection Control.2017;16(8):730-732. doi:10.3969/j.issn.1671-9638.2017.08.009

Objective To study clinical efficacy of ganciclovir in the therapy of infectious mononucleosis in adults.Methods 66 adults with infectious mononucleosis in a hospital from January 2010 to December 2014 were studied retrospectively,according to drug therapy,patients were divided into ganciclovir therapy group(n=31)and symptomatic therapy group(n=35),clinical features before therapy,therapeutic efficacy,and Epstein-Barr virus(EBV)DNA negative conversion time were analyzed.Results The time of defervescence,sore throat improvement,EBV-DNA negative conversion,subside of enlarged lymph node,and transaminase recovery in ganciclovir therapy group were all shorter than symptomatic therapy group(all P<0.05).Blood routine recovery time between two groups was not significantly different(P>0.05).Conclusion Ganciclovir has a good antiviral effect on the therapy of adult infectious mononucleosis,it can rapidly relieve patients from clinical symptoms including fever,sore throat and so on.

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Effect of targeted monitoring and comprehensive intervention on reducing catheter-associated urinary tract infection in patients in non-intensive care unit

Li KONG ; Yusen LI ; Zhankui ZHAO ; Huifang HU ; Jinfeng GUO ; Hong LIU ; Juan WANG ; Jixia WANG ; Miao LIU ; Ning LI ; Xia YUE ; Dingding ZHANG ; Yonghui MA

Chinese Journal of Infection Control.2017;16(8):721-725. doi:10.3969/j.issn.1671-9638.2017.08.007

Objective To evaluate the effect of targeted monitoring and comprehensive intervention measures on reducing the occurrence of catheter-associated urinary tract infection(CAUTI)in patients in non-intensive care unit(Non-ICU).Methods In quarter 4 of 2015,patients with indwelling urinary catheter in clinical departments were conducted a baseline survey(before intervention),risk factors for CAUTI in patients were analyzed,targeted monitoring programmes and comprehensive intervention measures were initiated in 2016(after intervention),incidence of CAUTI before and after intervention was compared.Results After taking intervention measures,hand hygiene compliance rate increased from 78.51%in quarter 4 of 2015 to 92.99%in quarter 3 of 2016 and 90.73%in quarter 4 of 2016(x2=7.342,3.998,respectively,both P<0.05),the correct disposal rate of patients' urinary catheterization system increased from 72.83%in quarter 4 of 2015 to 95.44%in quarter 4 of 2016(x2=30.267,P<0.05).A total of 12 067 patients with indwelling urinary catheter were monitored,incidence of CAUTI dropped from 1.03%(24/23 313)in quarter 4 of 2015(before intervention)to 0.53%(14/26 595)in quarter 4 of 2016(after intervention),difference was statistically significant(x2=4.126,P=0.042).Conclusion Improving the quality of urinary catheterization system in patients with indwelling catheter through targeted monitoring can effectively reduce the incidence of CAUTI in patients in Non-ICU.

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Present situation of healthcare-associated infection management and prevention and control of multidrug-resistant organisms in Hubei Province

Qiao HU ; Xing MING ; Yaqing XU ; Jiansheng LIANG ; Xiaoli LIU ; Min XU ; Duoshuang XIE ; Min DENG

Chinese Journal of Infection Control.2017;16(8):717-720. doi:10.3969/j.issn.1671-9638.2017.08.006

Objective To understand the basic situation of healthcare-associated infection(HAI)management and prevention and control of multidrug-resistant organism(MDRO)infection in medical institutions in Hubei Province.Methods Questionnaires were used to investigate the basic situation of HAI management and MDRO infection in 47 tertiary and secondary hospitals in Hubei Province.Results 47 hospital were enrolled in this study,HAI management full-time staff was allocated with a median of 0.90/250 beds;in 2015,the isolation rates of methicillin-resistant Staphylococcus aureus,carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Pseudomonas aeruginosa,carbapenem-resistant Acinetobacter baumannii,and vancomycin-resistant Enterococcus were 39.13%,4.13%,19.44%,63.60%,and 2.77%respectively.47 hospitals all carried out surveillance on MDROs,28(59.57%)hospitals were installed HAI monitoring system software,could directly obtain data through collecting with the laboratory system.The diagnosis of MDRO infection was mainly based on the combined diagnosis by HAI full-time personnel and clinicians(26 hospitals,55.32%).44(93.62%)hospitals regularly convened coordination meeting on prevention and control of MDROs,in 2015,hand hygiene compliance rate were 10.0%-89.2%by self-inspection;42(89.36%)hospitals routinely prescribed isolation orders for patients with MDRO infection,33(70.21%)hospitals conducted environmental clean and disinfection twice a day,24(51.06%)hospitals performed personal protection by using complete set of protective equipment.Conclusion This investigation is helpful for understanding the general situation of HAI management in medical institutions,as well as the detection and control of MDROs in this area,and make continual improvement on the problems and weakness found in the investigated project,so as to promote the development of HAI management in this area.

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Prevalence rates of healthcare-associated infection in a tumor hospital in 3 years

Jie NI ; Hongfang ZHOU ; Guangming GONG ; Junwei XU ; Li SUN ; Xiaoyan WU ; Jibin LIU

Chinese Journal of Infection Control.2017;16(8):714-716. doi:10.3969/j.issn.1671-9638.2017.08.005

Objective To investigate the prevalence of healthcare-associated infection(HAI)in a tumor hospital,and provide evidence for prevention and control of HAI.Methods According to requirement of cross sectional survey of nationwide HAI monitoring network,prevalence rates of HAI in hospitalized patients at a tumor hospital in 2013-2015 were surveyed,surveyed results were statistically analyzed.Results A total of 3 515 hospitalized patients were investigated from 2013 to 2015,24(0.68%)had HAI.The prevalence rates of HAI from 2013 to 2015 were 0.79%,0.54%,and 0.76%respectively,difference was not statistically significant(x2=0.65,P>0.05).The main infection site was lower respiratory tract,accounting for 45.83%.The main pathogens causing HAI were gram-negative bacilli,accounting for 47.37%,followed by fungi(26.32%).Conclusion The prevalence rate of HAI in tumor patients is low,targeted monitoring should be carried out according to the current situation,the prevention and control of lower respiratory tract infection should be focused on,fungal infection should be paid attention.

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Antimicrobial use density and antimicrobial resistance of isolated pathogens in hospitalized patients from 2011 to 2015

Jimei WANG ; Tingshan LI ; Xiaojuan SHA ; Shoumei ZHAO

Chinese Journal of Infection Control.2017;16(8):702-707. doi:10.3969/j.issn.1671-9638.2017.08.003

Objective To understand the distribution and change in drug resistance of common pathogens before and after the implementation of special rectification activity on antimicrobial use in 2011-2015,and provide guidance for clinical application of antimicrobial agents.Methods Antimicrobial use in hospitalized patients and pathogens isolated from patients in a hospital from 2011 to 2015 were collected,changing trend of resistance rates of major pathogens to commonly used antimicrobial agents was analyzed.Results From 2011 to 2015,antimicrobial utilization rate in hospitalized patients dropped from 75.84%to 37.35%,antimicrobial use density decreased from 59.53 per 100 patient days to 33.63 per 100 patient days,both showed a downward trend(both P<0.05).A total of 10 091 strains of pathogens were isolated,2 338(23.17%)of which were gram-positive bacteria,7 110(70.46%)were gram-negative bacteria,and 643(6.37%)were fungi.The top five pathogens were Escherichia coli(20.85%),Klebsiella pneumoniae(15.90%),Pseudomonas aeruginosa(11.70%),Staphylococcus aureus(7.35%),and Acinetobacter baumannii(6.82%).Resistance rates of major pathogens to commonly used antimicrobial agents decreased year by year(P<0.05),resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin/tazobactam,cefoxitin,and amikacin declined most obviously(all<4%in 2015);compared with Acinetobacter baumannii,Pseudomonas aeruginosa had higher sensitivity to commonly used antimicrobial agents,resistance rates to piperacillin/tazobactam,cefoperazone/sulbactam,ceftazidime,cefepime,amikacin,and ciprofloxacin decreased obviously,resistance rate to above antimicrobial agents was <20%,to carbapenems was higher than other commonly used antimicrobial agents.Resistance rates of Acinetobacter baumannii to amikacin,levofloxacin decreased most obviously,to meropenem and imipenem increased obviously,in 2015 were both above 50%.Resistance rate of Staphylococcus aureus to fluoroquinolones declined most obviously(<2%),vancomycin-resistant strains were not found.Conclusion After the implementation of special rectification activity,resistance rates of common pathogens decreased with the decline of antimicrobial use,rational use of antimicrobial agents may be related to delaying bacterial resistance.

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Three methods for microbiological monitoring on dialysate and dialysis water for hemodialysis

Xuefeng QIAN ; Meizhen QIAO ; Meijuan JIN ; Wenxia MA ; Bo YANG

Chinese Journal of Infection Control.2017;16(8):698-701. doi:10.3969/j.issn.1671-9638.2017.08.002

Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.

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Antimicrobial resistance profile and homology of carbapenem-resistant Klebsiella pneumoniae isolated from patients and related surroundings

Zhulan YANG ; Zhen ZHANG ; Zhiyong LIU ; Hao WU ; Bo ZHANG

Chinese Journal of Infection Control.2017;16(8):693-697. doi:10.3969/j.issn.1671-9638.2017.08.001

Objective To understand the homology of clinical isolates from patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection and isolates from environment in a medical institution.Methods One CRKP strain isolated from a patient in this hospital and 4 strains of Klebsiella pneumoniae(K.pneumoniae)isolated from patient's surroundings were collected,susceptibility of 5 strains to commonly used antimicrobial agents was detected,production of carbapenems in 5 strains were detected by modified Hodge testing and carbapenem inactivation method(CIM),homology analysis was performed by pulsed-field gel electrophoresis(PFGE).Results Antimicrobial susceptibility testing results showed that 5 strains of K.pneumoniae(1 from patient,4 from the patient's ward surroundings,including hands of nursing aides,solution bottle opening,handle for lifting and dropping bed,and bedrail)were all resistant to other antimicrobial agents except to cephamycin and aminoglycosides.The modified Hodge testing and CIM confirmed that 5 strains all produced carbapenemases;PFGE results showed that electrophoretogram of CRKP isolated from solution bottle opening of ward,bedrail,and handle for lifting and dropping bed were the same as CRKP isolated from patient,while electrophoretogram of CRKP isolated from hands of nursing aides had 2 different bands,there was a close relationship between the strains.Conclusion The same type of CRKP were isolated from patient and his surroundings,it is necessary to implement healthcare-associated infection(HAI)control system,isolate infected patient,and strengthen environmental cleaning and disinfection,so as to avoid the outbreak of HAI.

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Association between genetic polymorphism of CYP3A4, CYP2D6 and response to methadone maintenance treatment

Jianli DUAN ; Rui LUO ; Xingli LI ; Jianzhong HU ; Fang XIONG

Chinese Journal of Infection Control.2017;16(8):760-763. doi:10.3969/j.issn.1671-9638.2017.08.017

Objective To explore the association between the genetic polymorphism of CYP3A4,CYP2D6 and response to methadone maintenance treatment(MMT)among heroin-dependent patients.Methods Patients undergoing MMT in 6 MMT clinics were randomly selected,information about general socia-demographic characteristics,drug abuse history,and MMT data of patients were collected,genotypes of peripheral blood CYP3A4 and CYP2D6 polymorphic loci were detected.Results A total of 820 patients were enrolled in the study,210 cases were with good response and 610 cases with poor response to MMT.Difference in age between different response groups was statistically significant(P<0.05).Distribution of genotype frequency and allele frequency of CYP3A4 rs2242480 and CYP2D6 rs16947 between good response and poor response groups was not significantly different(both P>0.05).Conclusion The association between CYP3A4 rs2242480,CYP2D6 rs16947 and response to MMT has not yet found in heroin-dependent patients.

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Observation on expiration date and disinfectant efficacy of an alcohol-based hand disinfectant

Jun LEI ; Xun HUANG ; Xiaomei HAN ; Xin HUANG ; Jie LI ; Qingya DOU ; Chenchao FU

Chinese Journal of Infection Control.2017;16(8):757-759. doi:10.3969/j.issn.1671-9638.2017.08.016

Objective To understand the expiration date of alcohol-based hand disinfectant after it is opened for use,and provide reference for rational clinical application of alcohol-based hand disinfectant.Methods 20 bottles of the same brand alcohol-based hand disinfectant which opened at the same time by the clinical departments were selected as the study object,hand hygiene compliance in theses departments ranked fourth from the end in the hospital,specimens were taken on the first day after opening,and repeated every 10 days until the disinfectant was used up.Hand specimens were also taken after disinfected by disinfectant.Qualified condition of disinfectant and hand specimens was detected.Results A total of 98 disinfectant specimens were collected,by naked eye observation,20 bottles of alcohol-based hand disinfectant were free of discoloration,precipitation,and suspended matter during the whole study period.The qualified detection rates of alcohol-based hand disinfectant within 60 days after opening were all 100%.44 hand specimens were taken and detected after disinfection,3 of which were unqualified(all were disinfected by alcohol-based hand disinfectant 50 days after opening),then detected again after disinfected by the same batch of disinfectant,all were qualified,which suggested that unqualified detection result of hand specimens was not due to disinfectant.Conclusion Alcohol-based hand disinfectant still has a good bactericidal effect on the sixth day after opening.

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Occupational exposure to HIV and causes of HIV infection among nursing staff

Ling FENG ; Rongrong YANG ; Xien GUI ; Qian CAO

Chinese Journal of Infection Control.2017;16(8):752-756. doi:10.3969/j.issn.1671-9638.2017.08.015

Objective To analyze the infection among nursing staff after occupational exposure to human immunodeficiency virus(HIV)and status of HIV-infected nursing staff,provide basis for prevention of HIV infection among nursing staff.Methods Nurses who sustained HIV occupational exposure in a hospital between January 2004 and June 2015,nurses with positive anti-HIV and admitted to this hospital,consulted in outpatient department,as well as consulted outside this hospital between January 2001 and December 2015 were and analyzed,HIV infection status among nurse's mate was also analyzed.Results 76 nurses who sustained HIV occupational exposure didn't infect with HIV after received standard treatment and follow-up.Among 13 nurses infected with HIV,3 might be with occupational exposure infection previously,5 were with blood transfusion-related infection in the 1990s,4 were with sexually transmitted infection(including 2 male nurses who had sex with man,MSM),1 case with infection of unknown transmission route;secondary transmission occurred in 2 cases;9 nurses are still alive.The infected nurses have received effective antiretroviral treatment and then work at the logistic or administrative department.Conclusion Nurses often suffer from occupational exposure to HIV,occupational exposure infection may occur in the absence of the implementation of standardized management,implementation of standardized management is essential to avoid the occupational exposure of HIV.Sexual transmission(including MSM)has become an important transmission route for HIV infection among nurses.

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