Objective:To explore the effects of online and offline peer support on the quality of life in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) in the community.Methods:Two sub-communities were selected from a community health service center in Hengyang, Hunan province, and randomly divided into the control community and the intervention community by coin tossing. From November 2018 to March 2019, totally 40 middle-aged and elderly T2DM patients who met inclusion criteria were enrolled from the control and intervention communities and included into the control group and the intervention group, respectively. Patients in the control group received routine community care, while patients in the intervention group received online and offline peer support for 6 months on the basis of routine care. The quality of life, body mass index (BMI) and fasting blood glucose (FBG) were compared between the two groups before intervention, 3 months and 6 months after intervention.Results:After 3 months of intervention, the psychological function, social relationship, quality of life scores of the intervention group were lower than those of the control group, and the differences were statistically significant ( P< 0.05) ; after 6 months of intervention, the psychological function, social relationship, quality of life, BMI and FBG of the intervention group were lower than those of the control group, and the differences were statistically significant ( P< 0.01) . Conclusions:Online and offline peer support can decrease the FBG, improve psychological function and social relationship of middle-aged and elderly T2DM patients in the community, and improve their quality of life.

Objective? To explore the current situation of health empowerment of elderly fragility fracture patients and to analyze its influencing factors. Methods? We selected four Class Ⅲ Grade A hospitals randomly in Hengyang. From October 2017 to February 2018, a total of 176 elderly fragility fracture inpatients were investigated with the self-designed general information questionnaire, Elderly Frailty Assessment Scale, Osteoporosis Self-Efficacy Scale (OSES), Health Empowerment Scale for Elderly Patients with Chronic Disease. Multiple linear regression analysis was used to explore the influencing factors of health empowerment of patients. Results? The score of health empowerment of elderly fragility fracture patients was (89.00±14.31) and responsibility belief dimension was with the highest score (3.74±0.88). Patients' health empowerment had a negative correlation with the frailty (r=-0.576, P＜0.01) and had a positive correlation with the self-efficacy (r=0.496, P＜ 0.01). Multiple linear regression analysis showed that the main influencing factors of health empowerment of patients included ages, education levels, medical payment methods, frailty and self-efficacy (P＜0.05). Conclusions? Nurses should pay attention to patients' health empowerment ability and provide the individualized nursing to strengthen the health empowerment ability of elderly fragility fracture patients.

Objective To evaluate the feasibility of using neutrophil bactericidal activity assay for analyzing the anti-bactericidal ability of hypervirulent Klebsiella pneumoniae ( hvKP) strains that harbored the virulence genes of rmpA and rmpA2 and were positive for string test .Methods A total of 150 non-duplicate blood-borne Klebsiella pneumoniae strains were collected from Zhejiang Province from January 2016 to July 2017.PCR was performed to detect carbapenem resistance genes (blaKPC, blaNDM, blaIMP-1, blaIMP-2), cap-sule genotypes (K1, K2, K5, K20, K54 and K57) and virulence genes (rmpA, rmpA2, iucA and iroN). Klebsiella pneumoniae strains that were positive for string test and harbored rmpA and rmpA2 genes were iden-tified as hvKP strains, while classic Klebsiella pneumoniae (cKP) strains were negative for string test, rmpA or rmpA2 gene.Neutrophil bactericidal activity assay was performed to analyze the virulence of Klebsiella pneumoniae strains and the survival rate was determined by using the following equation: the number of colony-forming units ( CFUs) in experimental group divided by the number of CFUs in control group .Re-sults Of the 150 Klebsiella pneumoniae strains, 43.3％ (65/150) harbored the rmpA2 gene and among them, strains positive for genes of rmpA, iroN and blaKPC and K2 respectively accounted for 73.8％, 80.0％, 75.4％and 40.0％.Twenty-four (36.9％) rmpA2 gene-positive strains showed positive result of string test.The survival rates of hvKP and cKP groups were respectively 0.866±0.056 and 0.368±0.058 and the difference between them was statistically significant (P<0.001).Conclusion Most of the hvKP strains that carry rmpA and rmpA2 genes and are positive for string test in Zhejiang Province survive the neu-trophil treatment , which indicates that the neutrophil bactericidal activity assay is an effective and simple method for identifying the virulence of Klebsiella pneumoniae.

Objective To investigate the resistance of clinical isolated gram negative bacilli to tigecycline.Methods One hun-dred and fifteen Escherichia coli isolates,110 Klebsiella pneumoniae isolates and 99 Acinetobacter calcoaceticus-Acinetobact-er baumannii complex isolates were collected from Affiliated Second Hospital of Zhejiang University College of Medicine from the year 2012.The other 393 A.calcoaceticus-A .baumannii complex isolates were collected from 15 hospitals of nine cities in Zhejiang province during September to October 2012.Species identification and susceptibility test were confirmed by VITEK-2 compact system,while the 393 A.calcoaceticus-A .baumannii complex strains isolated from Zhejiang province were identified by MALDI-TOF MS.Moreover,159 A.baumannii isolates with tigecycline MIC value ≥8 μg/ml or 4 μg/ml and part of the MIC value ≤0.5 μg/ml,1 μg/ml and 2 μg/ml which were firstly determined by VITEK 2 GN AST-16 Suscepti-bility card were then determined by Etest.Results The 393 A.calcoaceticus-A .baumannii complex strains were identified as 317 of A.baumannii,32 of A.pittii and 44 of A.nosocomialis.When using the FDA breakpoints,the resistance rate of tige-cycline against 115 E.coli isolates,110 K.pneumoniae isolates and 99 A.calcoaceticus-A .baumannii complex isolates were 0.0%,7.3% and 6.1%,respectively.Interestingly,85.7% of the tigecycline-resistant gram negative bacilli were resistant to carbapenems.However,only 10.0% of the carbapenem-resistant gram negative bacilli were resistant to tigecycline.Conclu-sion Tigecycline had a good activity against clinical isolated multi-drug resistant or even pan-drug resistant gram negative bacilli.No matter which criteria for tigecycline was referred to,the resistance rate oftigecycline was slightly lower by Etest than by GN AST-16 Susceptibility card.

Objective To investigate the molecular types of carbapenem-non-susceptible Esche-richia coli ( E.coli) isolates and their mechanism of carbapenem resistance .Methods Twenty-two carbap-enem-non-susceptible E.coli strains were isolated from 3 hospitals in Hangzhou from 2007 to 2011.The mini-mum inhibitory concentrations ( MICs) of antimicrobials to those isolates were determined by agar dilution method and E-test.The molecular mechanisms of carbapenem resistance of E.coli isolates were analyzed by conjugation experiment,PCR and DNA sequencing.Pulsed-field gel electrophoresis (PFGE),multilocus se-quence typing ( MLST ) , and phylogenetic typing were performed to analyze the molecular epidemiology of those isolates.Results The MICs of imipenem and meropenem to 22 E.coli isolates were ranged from 1 μg/ml to 16 μg/ml,and the MICs of ertapenem were 2 μg/ml to 64 μg/ml.All E.coli isolates produced the KPC-2 carbapenemase and various β-lactamases , and some of them also produced plasmid-mediated AmpC enzymes.Carbapenem resistance was transferred by conjugation and transformation from 22 E.coli iso-lates to E.coli EC600 strains.The E.coli transconjugants or transformants acquired the blaKPC-2 gene and showed similar antibiotic susceptibility patterns in comparison with donor strains .Only a few isolates were in-distinguishable or closely related as indicated by PFGE .Four sequence types including ST131 (9 isolates), ST648 (5 isolates),ST38 (2 isolates) and ST405 (2 isolates) were identified by MLST.Phylogenetic analy-sis indicated that 9 ST131 isolates belonged to phylogenetic group B 2 and the other isolates belonged to group D (11 isolates),group B1 (1 isolate) and group A (1 isolate),respectively.Conclusion The sequence type of prevalent E.coli isolates producing KPC-2 from Hangzhou was ST131,which is an international epi-demic,multidrug-resistant clone,followed by ST648.

Objective To investigate the molecular epidemiology and resistance mechanism of reduced carbapenem susceptibility of Proteus mirabilis from intensive care unit (ICU).Methods Nineteen carbapenem resistance or reduced carbapenem susceptibility of Proteus mirabilis were isolated from two ICUs in Second Afiliated Hospital of Zhejiang University from August 2010 to October 2010.Pulsed-field gel electrophoresis (PFGE) was performed to analyze the molecular epidemiology of isolates.Antibiotic susceptibilities were determined by agar dilution method.Conjugation experiments were carried out in mixed broth cultures.Plasmid DNAs were obtained by using an alkalinelysis technique.Specific polymerase chain reaction (PCR) and DNA sequencing were preformed to confirm the genotype of β-lactamases. Results Nineteen Proteus mirabilis showed resistance or reduced carbapenem susceptibility,and were resistant or susceptible to cephalosporins.PFGE analysis indicated that nineteen carbapenem-non-susceptible Proteus mirabilis belonged to 3 clones,named as clone A (14 isolates),clone B (2 isolates of subclone B1 and 2 isolates of subclone B2 ) and clone C (1 isolate).Fourteen clone A isolates were indistinguishable,and subclone B1 and subclone B2 were closely related with only one fragment disparity.Escherichia coli (EC600) acquired an approximately 45 000 bp,54 000 bp and 45 000 bp plasmids from clone A,subclone B1 and subclone B2 isolates separately by conjugation studies.PCRs and DNA sequence analysis confirmed that all Proteus mirabilis isolates and their transconjugants produced the KPC-2 carbapenemase. Conclusion Carbapenem-non-susceptible Proteus mirabilis were epidemic in two ICUs in our hospital,and were clonally disseminated.

Objective To compare the capability of ertapenem-hydrolyzing in various concentrations in KPC-producing Enterobacteriaceae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry( MALDI-TOF MS).Methods Nineteen KPC-producing Enterobacteriaceae including ten Proteus mirabilis isolates,three Enterobacter aerogenes isolates,two Serratia marcescens isolates,two Citrobacter freundii isolates,one Klebsiella pneumoniae isolate and one Enterobacter cloacae isolate were isolated from 2nd Affiliated Hospital of Zhejiang University; Seven KPC-producing Morganella morganii were isolated from Hangzhou Traditional Chinese Medicine Hospital; Eleven Escherichia coli transconjugants produced the KPC-2 carbapenemase gene were conjugated from seven M.morganii and four P.mirabilis.MALDI-TOF MS was used to detect the ertapenem-hydrolyzing capability in different KPC-producing Enterobacteriaceae.Results When the concentration of ertapenem was 0.1 g/L,ertapenem can be hydrolyzed by KPC carbapenem within 1.5 h and the sensitivity was 100％,all the three peaks produced by ertapenem disappeared; when the concentration of ertapenem raised to 0.3 g/L,the sensitivity fell to 70.3％ (26/37) within 1.5 h,followed with 89.2％ ( 33/37 ) within 2.5 h and 94.6％ (35/37) within 3.5 h; when the concentration of ertapenem raised to 0.5 g/L,the sensitivity was 48.6％ (18/37) within 1.5 h,83.8％ (31/37) within 2.5 h,94.6％ (35/37 ) within 3.5 h.Two independent samples tests indicated that 0.1 g/L of ertapenem group has significant difference with 0.3 g/L and 0.5 g/L group,while there was no significant difference between 0.3 g/L group and 0.5 g/L group; As for the bacteria groups,there are no significant differences between the bacteria groups except the group of P.mirabilis and E.coli.Conclusion MALDI-TOF MS was easy to operate; it can rapidly detect KPC-producing Enterobacteriaceae with high sensitivity and a low false positive rate.0.1 g/L of ertapenem was recommended to detect KPC carbapenem rather than 0.3 g/L and 0.5 g/L; The detection time is short and can be widely applied clinically.

Objective To investigate the linezolid resistance mechanisms and molecular epidemiology of clinical isolates of methicillin-resistant coagulase-negative staphylococci (MRCoNS).Methods Seventeen MRCoNS,including 10 S.capitis,4 S.cohnii,2 S.haemolyticus,and 1 S.sciuri with various levels of linezolid resistance were isolated from intensive care units in our hospital from March to August 2011. Minimal inhibitory concentration (MIC) was determined by E-test method. Pulsed-field gel electrophoresis was performed to analyze the molecular epidemiology.PCRs and DNA sequencing were preformed to investigate the mechanisms of linezolid resistance in MRCoNS.Results Nine S.capitis with linezolid MIC of ＞256 μg/ml were indistinguishable,and another S.capitis with linezolid MIC of 4 μg/ml was closely related.Four S.cohnii with linezolid MIC of ＞256 μg/ml were belonged to the same clonal strain.MIC of linezolid for S.sciuri was 64 μg/ml,and were 4 μg/ml and 6 μg/ml for 2 S.haemolyticus,respectively.A commom G2576T mutation and a novel C2104T mutation were identified in 9 S.capitis with linezolid MIC of ＞256 μg/ml by DNA sequence analysis of domain V of the 23S rRNA gene.cfr gene was deteeted in all staphylococci except a S.sciuri whose 23S rRNA gene contained the G2576T mutation.Conclusion It is the first report of linezolid-resistant clinical isolates of staphylococci in China.Linezolid resistance in MRCoNS is related to the presence of DNA mutation in domain V of the 23S rRNA gene and cfr gene.It's a clonally dissemination of linezolid-resistant MRCoNS in intensive care units of our hospital.

Objective To detect carbapenemase production in enterobacteriaceae by using modified Hedge test (MHT) and investigate the distribution of carbapenemase genes.Methods A total of 3 718 isolates from enterobacteriaceae were collected from 4 hospitals,including Second Affiliated Hospital of Zhejiang University,People's Hospital of Dongyang,Beijing Hospital,and Huaxi Hospital of Sichuan University.Susceptibility of enterobacteriaceae to ertapenem was tested by K-B method.MHT was used to detect carbapenemase in enterobacteriaceae and the common carbapenemase genes were amplified by using PCR.Results The total resistance rate ( resistance and intermediate resistance) of enterobacteriaceae to ertapenem was 3.04％ (113/3718) and there were differences in resistance rate of enterobacteriaceae to ertapenem among 4 hospitals (5.09％,2.15％,2.59％,and 1.72％,respectively).Of the 3718 isolates,2.29％ (85) were positive to MHT,and there were differences in positive rate to MHT among 4 hospitals (4.73％,1.21％,1.06％,and 1.58％,respectivdy).Of 113 non-susceptible isolates to ertapenem,82 were positive to MHT and 31 were negative.Of 85 MHT-positive isolates,82 were resistant or intermediate resistant to ertapenem and only 3 were susceptible.Of 82 MHT-pesitive and non-susceptible isolates to ertapenem,65 were positive to KPC gene,15 were positive to IMP gene (two of them were positive to both KPC and IMP),and 4 were negative to all tested carbapenemase genes.Thirty-one MHT-negative and nonsusceptible to ertapenem and 3 MHT-positive and susceptible isolates to ertapenem were negative to all tested carbapenemase genes.Conclusions MHT is used to detect carbapenemase in enterobacteriaceae with high sensitivity and low false positive rate.KPC gene is the most occurred gene to be dominant in the production of carbapenemase in enterobacteriaceae, and the IMP gene is also responsible to the genesis ofcarbapenemase in enterobacteriaceae..

Objective To investigate the resistance of Acinetobacter baumannii to clinical common antibiotics and new drug tigecycline. Methods Six hundred and two Acinetobacter baumannii isolates were collected from 2008 to 2009 in four teaching hospitals in Zhejiang province. Agar dilution method was used to detect the resistance of 13 clinical commom antibiotics, polymyxin B and tigecycline. Homology analysis of 24 multi-drug resistant Acinetobacter baumannii strains was used to investigate the relationship of each strain with the method of pulsed field gel electrophoresis. Results From 2008 to 2009, the Acinetobacter baumannii isolates of four teaching hospitals in Zhejiang province were mainly isolated from respiratory specimens with the number of 277 (86.0%) strains in 2009, the number of blood samples decreased from 15 (5.4%) strains in 2008 to 5 ( 1.5% ) strains in 2009, and there were no obvious change in other specimens. Acinetobacter baumannii strains were resistant to 13 clinical common antibiotics at different degree, fluctuated from 35.0% to 85.0%. Compared with the resistance in 2008, levofloxacin and tobramyxin decreased 0. 9% and 9.0% in 2009, respectively. However, the resistance of other antibiotics increased at different degree, the resistance of ceftriaxone and cefepime increased about 10.0%, and the resistance of imipenem and meropenem increased to 74.2% (239/602) and 70.8% (228/602) in 2009,respectively. Acinetobacter baumannii showed high resistance to tigecycline with the percent of 78.9% (475/602), while it was only 3.7% (22/602) for polymyxin B. There were six cloning types among the 24 Acinetobacter baumannii isolates, and the most common type was type A with the percent of 50%.Conclusions The resistance of tigecycline makes the situation of nosocomial infectious more serious. It is necessary to control the transmission of multi-drug resistant Acinetobacter baumannii immediately.