OBJECTIVE To understand the clinical distribution of carbapenem-resistant gram-negative bacteria(CR-GNB)hospital-acquired infections and observe the effectiveness of antimicrobial stewardship(AMS)so as to pro-vide theoretical basis for targeted supervision.METHODS The patients who were detected with CR-GNB in the First People's Hospital of Lianyungang from Jan.1,2015 to Dec.31,2023 were monitored by hospital-ac-quired infection informatization monitoring system,the demographic and etiological data were collected from the patients with hospital-acquired infections,the clinical characteristics were analyzed.The incidence of CR-GNB in-fections,isolation rates and drug administration indexes were observed and compared,and the effectiveness of AMS was evaluated.RESULTS A total of 972 633 hospitalized patients were monitored,1319 of whom had hospi-tal-associated CR-GNB infections,and the total incidence of infections was 0.17％,showing a continuously down-ward trend during the years(P＜0.001).Carbapenem-resistant Acinetobacter baumannii(43.37％),carbapenem-resistant Pseudomonas aeruginosa(29.72％)and carbapenem-resistant Klebsiella pneumoniae(24.94％)ranked the top 3 species of pathogens.The CR-GNB infections were most prevalent in intensive care unit(ICU),followed by geriatrics department and neurosurgery department.Lower respiratory tract was the predominant infection site.The patients of male,no less than 65 years of age,and ICU stay were at higher risk of CR-GNB infections than other populations(P＜0.001).The implementation of AMS reduced the incidence of CR-GNB infections,iso-lation rates,utilization rates of antibiotics,antibiotics prophylaxis rates for type Ⅰ incision surgery and antibiotics use density(P＜0.05).CONCLUSIONS The hospital-associated CR-GNB infection show"U"type epidemiological characteristics.It is necessary to focus on the population characterized by male/the elderly/ICU stay.The imple-mentation of AMS may effectively facilitate the control and detection rate of the CR-GNB infections.

OBJECTIVE To understand the clinical distribution of carbapenem-resistant gram-negative bacteria(CR-GNB)hospital-acquired infections and observe the effectiveness of antimicrobial stewardship(AMS)so as to pro-vide theoretical basis for targeted supervision.METHODS The patients who were detected with CR-GNB in the First People's Hospital of Lianyungang from Jan.1,2015 to Dec.31,2023 were monitored by hospital-ac-quired infection informatization monitoring system,the demographic and etiological data were collected from the patients with hospital-acquired infections,the clinical characteristics were analyzed.The incidence of CR-GNB in-fections,isolation rates and drug administration indexes were observed and compared,and the effectiveness of AMS was evaluated.RESULTS A total of 972 633 hospitalized patients were monitored,1319 of whom had hospi-tal-associated CR-GNB infections,and the total incidence of infections was 0.17％,showing a continuously down-ward trend during the years(P＜0.001).Carbapenem-resistant Acinetobacter baumannii(43.37％),carbapenem-resistant Pseudomonas aeruginosa(29.72％)and carbapenem-resistant Klebsiella pneumoniae(24.94％)ranked the top 3 species of pathogens.The CR-GNB infections were most prevalent in intensive care unit(ICU),followed by geriatrics department and neurosurgery department.Lower respiratory tract was the predominant infection site.The patients of male,no less than 65 years of age,and ICU stay were at higher risk of CR-GNB infections than other populations(P＜0.001).The implementation of AMS reduced the incidence of CR-GNB infections,iso-lation rates,utilization rates of antibiotics,antibiotics prophylaxis rates for type Ⅰ incision surgery and antibiotics use density(P＜0.05).CONCLUSIONS The hospital-associated CR-GNB infection show"U"type epidemiological characteristics.It is necessary to focus on the population characterized by male/the elderly/ICU stay.The imple-mentation of AMS may effectively facilitate the control and detection rate of the CR-GNB infections.

Low-altitude unmanned technology represented by unmanned aerial vehicle (UAV) has shown broad application prospects in the medical field. Since June 2023, Affiliated Hospital of Jiaxing University The First Hospital of Jiaxing, focusing on the demand for medical supplies transport among hospitals, has led the construction and operation practice of a low-altitude transfer system for medical supplies featuring UAV. By establishing a management organizational structure, building a low-altitude digital intelligence platform, constructing UAV take-off and landing platforms, formulating and approving flight routes, and improving the medical supply distribution process, it successfully achieved the transportation of medical blood and biological specimens between Jiaxing Central Blood Station and relevant medical institutions, as well as among different campus and medical alliance units of Affiliated Hospital of Jiaxing University The First Hospital of Jiaxing. As of June 2024, a total of 6 routes have been opened within the Jiaxing municipal area, with a cumulative flight distance exceeding 5 000 km. A total of 64 flights for medical blood, 720 flights for blood specimens, and 5 flights for pathological specimens have been transported. Compared with land transportation methods, UAV transportation effectively shortened transportation time, enhanced the service capabilities and diagnosis and treatment quality of grassroots medical institutions, and also saved costs. It can provide a reference for other medical institutions to carry out low-altitude medical supplies distribution.

Low-altitude unmanned technology represented by unmanned aerial vehicle (UAV) has shown broad application prospects in the medical field. Since June 2023, Affiliated Hospital of Jiaxing University The First Hospital of Jiaxing, focusing on the demand for medical supplies transport among hospitals, has led the construction and operation practice of a low-altitude transfer system for medical supplies featuring UAV. By establishing a management organizational structure, building a low-altitude digital intelligence platform, constructing UAV take-off and landing platforms, formulating and approving flight routes, and improving the medical supply distribution process, it successfully achieved the transportation of medical blood and biological specimens between Jiaxing Central Blood Station and relevant medical institutions, as well as among different campus and medical alliance units of Affiliated Hospital of Jiaxing University The First Hospital of Jiaxing. As of June 2024, a total of 6 routes have been opened within the Jiaxing municipal area, with a cumulative flight distance exceeding 5 000 km. A total of 64 flights for medical blood, 720 flights for blood specimens, and 5 flights for pathological specimens have been transported. Compared with land transportation methods, UAV transportation effectively shortened transportation time, enhanced the service capabilities and diagnosis and treatment quality of grassroots medical institutions, and also saved costs. It can provide a reference for other medical institutions to carry out low-altitude medical supplies distribution.

Objective:To identify species type and analyze the homology of Brucella in a family cluster infection. Methods:Two patients with brucellosis from the same family who were treated at the First People's Hospital of Lianyungang City, Jiangsu Province in May 2022 were selected as the research subjects. Brucella strains (H4LYG01 and H2LYG02) were isolated through blood culture. The isolated strains were identified for species type and homology analysis using a fully automated microbial mass spectrometry detection system. Molecular typing of the isolated strains was performed using multiple locus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). Results:H4LYG01 and H2LYG02 were both Brucella Maltese, and the credibility scores were 9.745 and 9.627, respectively, and the homology was 100%. The MLVA results showed that the gene loci of H4LYG01 and H2LYG02 were completely identical, with the same genotype. The MLST results showed that the sequence type (ST) of H4LYG01 and H2LYG02 were both ST8 types. Conclusion:The two isolated strains of Brucella from a family with clustered infections are both Brucella Maltese and from the same source.

Objective:To construct a death education intervention program for advanced cancer caregivers to improve the reference for death education for advanced cancer caregivers.Methods:Content analysis, semi-structured interview, Delphi expert consultation method were used to develop a preliminary death education program based on the theory of knowledge, belief, and behavior. From April to May 2022, fifteen experts from palliative care, life and death education, oncology nursing, psychological nursing and other related fields were selected for two rounds of expert consultation, and the contents of the program were revised and improved through preliminary experiments.Results:After two rounds of expert consultation, the results showed that the expert opinions tend to be unanimous. The authoritative coefficient of experts was 0.87, and the Kendall coordination coefficients of feasibility, validity and scientificity of the two rounds of consultation were 0.181, 0.303, 0.363 and 0.249, 0.355, 0.366, respectively (both P<0.05). The preliminary experiments revised and improved the intervention frequency and content, and finally formed a death education intervention program for advanced cancer caregivers which included four-stage progressive death themes: made an appointment with death, made a discussion on death, made an embrace with death and made friends with death. Conclusions:The process of constructing a death education program for advanced cancer caregivers is scientific, and the content is feasible, valid, and scientific. In addition, it is of great significance to promote death education in palliative care.

Objective:To predict and evaluate the antibacterial efficacy of linezolid, teicoplanin and daptomycin against Staphylococci bloodstream infections with Monte Carlo simulation, and to optimize the clinical administration program. Methods:A total of 1 847 Staphylococci strains isolated from blood samples between January 2018 to December 2019 were collected with the help of the Blood Bacterial Resistant Investigation Collaborative System (BRICS). Minimum inhibitory concentrations (MIC) of linezolid and daptomycin were detected by broth dilution method, while MIC of teicoplanin were detected by agar dilution method. The dosage regimens of linezolid were 800 mg once daily, 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours. The dosage regimens of teicoplanin were 400 mg once every 12 hours, 600 mg once every 12 hours, 800 mg once every 12 hours, and 1 000 mg once every 12 hours. The dosage regimens of daptomycin were 4 mg·kg -1·d -1, 6 mg·kg -1·d -1, 8 mg·kg -1·d -1, 10 mg·kg -1·d -1and 12 mg·kg -1·d -1. The probability of target attainment (PTA) and cumulative fraction of response (CFR) of three different dosage regimens were calculated by Monte Carlo simulation. A dosage regimen with CFR≥90.0% was a reasonable choice for empirical antimicrobial therapy. Results:PTA of linezolid against Staphylococci when MIC≤0.500 mg/L at four dosage regimens (800 mg once daily, 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours) were all over 90.0%. When MIC was 1.000 mg/L, the PTA of linezolid against Staphylococci under the dosages of 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours were 92.2%, 96.6% and 97.6%, respectively. The CFR of the four dosage regimens of linezolid were 73.9%, 83.7%, 90.8% and 95.3%, respectively. When MIC≤1.000 mg/L, PTA of teicoplanin against Staphylococci were all 100.0% at four dosage regimens (400 mg once every 12 hours, 600 mg once every 12 hours, 800 mg once every 12 hours and 1 000 mg once every 12 hours). When MIC was 2.000 mg/L, the PTA of teicoplanin (800 mg once every 12 hours and 1 000 mg once every 12 hours) against Staphylococci were both 100.0%. The CFR of the four dosage regimens of teicoplanin were 90.8%, 92.8%, 93.5% and 94.6%, respectively. When MIC≤0.500 mg/L, PTA of daptomycin against Staphylococci under the five dosages of 4 mg·kg -1·d -1, 6 mg·kg -1·d -1, 8 mg·kg -1·d -1, 10 mg·kg -1·d -1 and 12 mg·kg -1·d -1 were all over 90.0%. When MIC was 1.000 mg/L, the PTA of daptomycin against Staphylococci under the three dosages of 8 mg·kg -1·d -1, 10 mg·kg -1·d -1 and 12 mg·kg -1·d -1were 96.9%, 100.0% and 100.0%, respectively. The CFR of the five dosage regimens of daptomycin against Staphylococci were 97.4%, 99.2%, 99.9%, 100.0% and 100.0%, respectively. Conclusions:Linezolid (600 mg once every 12 hours), teicoplanin (400 mg once every 12 hours) and daptomycin (4 mg·kg -1·d -1) can achieve satisfactory antibacterial activity for Staphylococci bloodstream infections.

Objective:To understand the biological characteristics, identification methods, genome structure and clinical significance of a rare strain of Aureimonas altamirensis isolated from clinical blood sample. Methods:The culture and biochemical characteristics of a strain isolated from blood culture were observed. The routine biochemical identification methods, MALDI-TOF mass spectrometer and 16S rRNA gene sequencing were used to identify the isolate. A phylogenetic tree based on the 16S rRNA gene sequences of the isolate and related strains was constructed. The genome of the isolated strain was sequenced and assembled, and gene prediction and functional annotation were made using related software. Phylogenetic analysis based on 31 house-keeping genes and genome-wide average nucleotide identity (ANI) analysis were conducted between the isolate and other Aureimonas sp. strains.Results:The isolated bacteria were gram-negative bacillus positive for catalase, urease and oxidase. It grew slowly on blood plate and could not be reliably identified by automatic bacterial biochemical identification systems or MALDI-TOF mass spectrometry. Results of the 16S rRNA gene sequencing and phylogenetic tree showed that the 16S rRNA gene sequence of the isolated strain was highly homologous to the strains of Aureimonas altamirensis NML070722 and IARI-ABL-26 (GenBank accession number: EU442518.1 and KC581669.1) in GenBank, and the gene sequence similarity was 99.93%. The total genome (National Microbiology Data Center genome accession number: NMDC60043566) length was 4 332 458 bp and GC content was 65.14%. There were 4 088 protein-coding genes and functional gene annotation showed that functional genes were mainly enriched in protein, amino acid, carbohydrate transport and metabolic functional regions. Pathogenic gene analysis predicted two high reliable virulence factor genes, but no drug resistance genes. House-keeping gene phylogenetic tree analysis showed that this strain was highly homologous to Aureimonas altamirensis strains of DSM21988 and C2P003 (GenBank accession number: GCF 001463885.1 and GCF 000800175.1), but ANI analysis showed that its genome was significantly different from those of the two strains. Conclusions:A rare strain of Aureimonas altamirensis was isolated from clinical specimen in China. As the biological and genomic characteristics of Aureimonas altamirensis had not been fully recognized, it was difficult to be correctly identified by conventional methods. The pathogenicity of Aureimonas altamirensis to immunocompromised patients and the significance of isolation in clinical specimens might need more case studies.

Objective:To study the genotyping characteristics of Brucella strains isolated from Lianyungang City (non-brucellosis epidemic area) of Jiangsu Province. Methods:Preliminary identification of 13 suspected strains of Brucella isolated from blood culture in Clinical Microbiology Laboratory of the First People's Hospital of Lianyungang City in 2018 was conducted; at the same time, the specific gene bcsp31 and insertion sequence IS-711 of Brucella were detected by quantitative real-time PCR (Real-time PCR), and the identification results were rechecked and typed. Multiple locus variable-number tandem repeat analysis (MLVA) was applied for genotyping, and the sequencing results were edited by Mega 4.0 software. Results:All the 13 strains were identified as Brucella by preliminary identification. Real-time PCR confirmed that all the 13 strains were Brucella melitensis. The results of MLVA showed that 13 strains of Brucella melitensis were divided into 12 genotypes and clustered in the "middle Mediterranean cluster". Among 13 strains of Brucella melitensis, 3 strains were biovar 1, 2 strains were biovar 2 and 8 strains were biovar 3. Conclusion:All the Brucella strains isolated from Lianyungang City are Brucella melitensis and the MLVA cluster is in the "middle Mediterranean cluster".

Objective To access the prevalence of type 2 diabetes mellitus ( T2DM) and its associated risk factors among adults with obesity in Zhejiang province. Methods The enrolled subjects were selected among local residents aged≥18 years with body mass index≥28 kg/m2 from 15 counties by multi stage stratified cluster random sampling from July to November, 2010. Each participant was required to attend complete questionnaire, physical examination, and testing overnight fasting blood specimen. Results A total of 1 351 residents were enrolled, including 613 males and 738 females. The prevalence of T2DM in adult population with obesity was 15. 03%, being 14. 03% in male, and 15. 85% in female;and that in urban area was 16. 64%, and in rural area was 13. 93%. Data from multivariable logistic regression showed that factors such as ageing (OR=1. 473, 95% CI 1. 243-1. 747), a family history of T2DM(OR=8. 945, 95% CI 5. 481-14. 598), staple food intake (OR=1. 185, 95% CI 1. 017-1. 380), triglyceride(≥1. 7 mmol/L, OR=1. 542, 95%CI 1. 066-2. 232) were risk factors of T2DM;while annual income(OR=0. 695, 95%CI 0. 544-0. 888), and milk intake(OR=0. 750, 95%CI 0. 567-0. 993) were shown as protective factors. Conclusion The prevalence of T2DM in adults with obesity was raised, ageing, a family history of T2DM, staple food intake, and dyslipidemia appeared to be major risk factors for T2DM.