OBJECTIVE To carry out regular monitoring of carbapenem-resistant Klebsiella pneumoniae(CRKP)contamination status in the environment of intensive care unit(ICU)and take targeted prevention and control measures so as to reduce the incidence of hospital-associated infections with multidrug-resistant organisms(MDROs).METHODS The surfaces of surroundings of the patients who were colonized and infected with CRKP in the ICU of grade A tertiary hospital of Shanghai and the hands of relevant staff were sampled by stages from Jan 1,2021 to Jun 30,2024.The distribution of the CRKP strains in the surroundings were analyzed according to the locations positive for CRKP,and the disinfection measures were accordingly and continuously modified.The trend of isolation rate of CRKP strains from the ICU patients was analyzed during the time period when the measures were implemented.RESULTS Totally 266 environmental samples were collected during the baseline period(from Jan.1 2021 to Dec.31 2021),265 during intervention period(from Jan.1 2022 to Dec.31 2023),274 during con-solidation period(from Jan.1 to Jun.30 2024);the isolation rates of the CRKP strains were 4.51％,4.91％and 3.65％,respectively.The isolation rate of the strains was highest from the bed unit(10.40％),followed by the article for public use(6.74％),articles used by health care workers(2.98％)and diagnosis and treatment arti-cles(1.91％).The isolation rate of CRKP of the patients was 24.75％during the baseline period,15.48％during the intervention period,5.69％during the consolidation period,showing a continuously downward trend(x2=30.330,P＜0.001).CONCLUSION It is necessary to regularly carry out the environmental monitoring of CRKP strains,seek for the weak links of environmental disinfection and implement the intensified prevention and control measures so as to reduce the incidence of CRKP infection,which may provide theoretical bases for effective control of the CRKP strains.

OBJECTIVE To carry out regular monitoring of carbapenem-resistant Klebsiella pneumoniae(CRKP)contamination status in the environment of intensive care unit(ICU)and take targeted prevention and control measures so as to reduce the incidence of hospital-associated infections with multidrug-resistant organisms(MDROs).METHODS The surfaces of surroundings of the patients who were colonized and infected with CRKP in the ICU of grade A tertiary hospital of Shanghai and the hands of relevant staff were sampled by stages from Jan 1,2021 to Jun 30,2024.The distribution of the CRKP strains in the surroundings were analyzed according to the locations positive for CRKP,and the disinfection measures were accordingly and continuously modified.The trend of isolation rate of CRKP strains from the ICU patients was analyzed during the time period when the measures were implemented.RESULTS Totally 266 environmental samples were collected during the baseline period(from Jan.1 2021 to Dec.31 2021),265 during intervention period(from Jan.1 2022 to Dec.31 2023),274 during con-solidation period(from Jan.1 to Jun.30 2024);the isolation rates of the CRKP strains were 4.51％,4.91％and 3.65％,respectively.The isolation rate of the strains was highest from the bed unit(10.40％),followed by the article for public use(6.74％),articles used by health care workers(2.98％)and diagnosis and treatment arti-cles(1.91％).The isolation rate of CRKP of the patients was 24.75％during the baseline period,15.48％during the intervention period,5.69％during the consolidation period,showing a continuously downward trend(x2=30.330,P＜0.001).CONCLUSION It is necessary to regularly carry out the environmental monitoring of CRKP strains,seek for the weak links of environmental disinfection and implement the intensified prevention and control measures so as to reduce the incidence of CRKP infection,which may provide theoretical bases for effective control of the CRKP strains.

Objective To analyze drug resistance phenotypes and clinical distribution characteristics of clinically isolated carbapenem-resistant Klebsiella pneumoniae(CRKP),and provide evidence for rational use of antimicrobial agents and control of healthcare-associated infection(HAI). Methods CRKP isolated from inpatients in a hospital in 2013-2015 were collected,sources of specimens and homology of antimicrobial susceptibility of pathogens were analyzed. Results Of 949 non-repetitive strains of Klebsiella pneumoniae,75 (7.90% )were CRKP strains. The detection rates of CRKP from 2013 to 2015 were 1.35% ,7.77% ,and 17.04% respectively,which showed an up-ward trend year by year,difference was statistically significant(P<0.01). The main infection sites of CRKP were respiratory tract and urinary tract,CRKP mainly distributed in intensive care unit(ICU),geriatrics and emergency departments. Susceptibility rates of CRKP to amikacin and trimethoprim/sulfamethoxazole were 57.33% and 48. 00% respectively. 22 (29.33% )cases of CRKP infection were community-acquired and 53 (70.67% )were health-care-associated infection. 18 (24.00% )cases died among 75 CRKP infected patients. According to drug resistance phenotype analysis,there were 5 clones of CRKP strains,mainly distributed in ICU,geriatrics and emergency de-partments.Conclusion The proportion of CRKP infection is increasing year by year,clinical monitoring on CRKP should be strengthened,intensive infection control measures should be tarken,so as to prevent and control the spread and prevalence of CRKP.

Objective To implement active screening measures for patients in intensive care unit (ICU),early de-tect patients with multidrug-resistant organism (MDRO)colonization,implement contact isolation measures,pre-vent and control MDRO cross transmission.Methods The nasal and rectal swabs of 240 patients who were admit-ted to ICU from September 2012 to May 2013 were performed bacterial culture,patients with colonization of methi-cillin-resistant Staphylococcus aureus (MRSA),extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli ,and ESBLs-producing Klebsiella pneumoniae were conducted contact isolation.Clinically isolated MDROs from ICU patients in September 2011-August 2012 (before active screening)and September 2012-August 2013 (after active screening)were collected and performed antimicrobial resistance analysis.Results Of 240 patients, nasal swabs screening test showed that there were 56(23.33%)patients who were colonized with MRSA,including 22(39.29%)were colonized at the admission to ICU and 34(60.71%)during the ICU stay.Rectal swabs screening test showed that there were 105(43.75%)patients who were colonized with ESBLs-producing Escherichia coli and Klebsiella pneumoniae ,72(68.57%)were colonized at the admission to ICU,and 33(31.43%)were colonized dur-ing the period of ICU stay.The incidence density of MDROs before and after implementing active screening were 28.56‰ and 13.71‰ respectively,difference was significant (P < 0.05;RR,2.08 [95%CI ,1.582 - 2.743]). Conclusion MDRO colonization rate is high among ICU inpatients,implementation of comprehensive prevention and control measures against MDROs based on active screening can reduce the spread of MDROs in ICU.

Objective To explore the effect of ventilator circuit change frequency on the incidence of ventilator-associated pneumonia (VAP). Methods Patients receiving mechanical ventilation in the ICU,Department of Emergency, Respiratory Department and Department of Neurosurgery from March 2008 to September 2010 were randomized into two groups. For these two groups ,the ventilator circuit was changed once or twice a week. The recorded parameters included the clinical symptoms and signs of the ventilated patients. Samples at different parts of the circuit were collected for microbiological detection. The data were analyzed statistically. Results The incidence of VAP was 28. 30% ( 13/53 ) in twice-a-week group and 35.84%( 19/53 ) in once-a-week group. There was no significant difference between the two groups. The rates for positive microbiological detection in the circuit were 48. 16% and 44. 49% for once-a-week and twice-a-week group,respectively. No significant difference was observed ( P ＞ 0.05 ). Moreover, there was no significant difference in terms of the microbiology positivity between different parts of the circuit(P ＞ 0. 05 ). Gram-negative bacteria were the main pathogen of VAP with Acinetobacter baumannii ranking at the top. Conclusion Frequency of Ventilator circuit change does not influence the incidence of VAP. We suggest that the frequency for ventilator circuit change should be once a week. At the same time, the nurse staff should be trained for specific technology and the incidence of hospital infection should be controlled at multiple rings of the chain.

OBJECTIVE To promote the multidrug-resistant bacteria infection control. METHODS Questionnaire investigated has been used to understand what degree the healthcare workers have known about controlling multidrug-resistant bacteria infection,what difficulties they would be met when they had put prevention and control measures in practice. RESULTS Total 13 questions of prevention and control multidrug-resistant bacteria nosocomial infection,the rate of right answer was 26.9% and the rate of partial right answer was 38.4%.The healthcare workers had lacked of professional knowledge about the prevention and control of multidrug-resistant bacteria nosocomial infection. The major difficulties were crowded wards,short of beds,incomprehension of patients and their families,cost of articles for disinfection and isolation when the medical staff put isolation measures into practice. CONCLUSIONS All prevention and control measures againt multidrug-resistant bacteria infection should be put into practice. We should strengthen training of healthcare workers about professional knowledge,gain support of leaders,and enhance communication between medical staff with patients and supervision.

OBJECTIVETo understand and improve the transdifferentiation of pancreatic stem cells into islet cells through isolation, cultivation and transdifferentiation of adult human pancreatic duct cells.

METHODSA portion of adult human pancreas was digested with collagenase, followed by incontinuous density gradient to separate islets from the acinar and ductal tissue. Duct epithelial cells were cultivated in CMRL1066 and then in serum-free DMEM/F12 medium with the addition of growth factors for 27 days. Samples were taken at different time points for light and electron microscopic examination and for immunocytochemical study with antibodies against transdifferentiation gene PDX-1 and protein CK-19. Amylase and insulin contents in the medium were assayed.

RESULTSA large number of duct epithelial cells were harvested after the isolation of islets. Some duct epithelial cells were PDX-1 and CK-19 positive at day one and duct epithelial cells proliferated and expanded rapidly and then transdifferentiated into stem cells and finally 3D islets. 760 islets were harvested from each gram of pancreatic tissue on day 27.

CONCLUSIONSAdult pancreatic duct cells are potential stem cells and could be transdifferentiated into islet cells in vitro under appropriate conditions.

Adult ; Cell Differentiation ; physiology ; Humans ; Islets of Langerhans ; cytology ; Pancreas ; cytology ; Stem Cells ; cytology