Objective To understand the distribution characteristics and antimicrobial resistance of Serratia mar-cescens(S.marcescens),provide evidence for rational application of antimicrobial agents as well as prevention and control of S.marcescens infection.Methods Electronic medical record data of hospitalized patients who were de-tected S.marcescens at Shengjing Hospital of China Medical University from 2017 to 2023 were collected and ana-lyzed statistically.Results From 2017 to 2023,a total of 388 strains of S.marcescens were detected,238 strains(61.34％)were isolated from male patients and 150 strains(38.66％)from female patients;95 strains(24.49％)were from children under 14 years old,144 strains(37.11％)were from adults under 60 years old,and 149 strains(38.40％)were from elderly people over 60 years old,33 strains were from newborns,accounting for 8.51％of the total strains and 34.74％of strains from children.From 2017 to 2023,the detection rate of S.marcescens remained relatively stable with small fluctuations(0.52％-0.60％),the detected specimens were mainly sputum(38.92％),with department of surgery(39.69％)being the most and department of gynecology and obstetrics being the least(1.55％).From 2017 to 2023,the resistance rate of S.marcescens to cefazolin was the highest(97.42％),fo-llowed by cefuroxime(71.13％),tetracycline(59.02％),cefamandole(57.47％),amoxicillin/clavulanic acid(44.59％),ampicillin/sulbactam(42.53％),cefoxitin(34.02％),chloramphenicol(15.21％),and furantoin(14.18％).The resistance rates of S.marcescens to quinolones from 2017 to 2023 were 0.52％-8.25％.Poly-myxin-resistant and tigecycline-resistant S.marcescens emerged in 2022 and 2023,respectively.Conclusion In clinical practice,antimicrobial agents should be selected rationally for the treatment of S.marcescens infection,and S.marcescens should be focused in monitoring as well as infection prevention and management,so as to prevent and control the occurrence of S.marcescens infection.

Objective To understand the distribution characteristics and antimicrobial resistance of Serratia mar-cescens(S.marcescens),provide evidence for rational application of antimicrobial agents as well as prevention and control of S.marcescens infection.Methods Electronic medical record data of hospitalized patients who were de-tected S.marcescens at Shengjing Hospital of China Medical University from 2017 to 2023 were collected and ana-lyzed statistically.Results From 2017 to 2023,a total of 388 strains of S.marcescens were detected,238 strains(61.34％)were isolated from male patients and 150 strains(38.66％)from female patients;95 strains(24.49％)were from children under 14 years old,144 strains(37.11％)were from adults under 60 years old,and 149 strains(38.40％)were from elderly people over 60 years old,33 strains were from newborns,accounting for 8.51％of the total strains and 34.74％of strains from children.From 2017 to 2023,the detection rate of S.marcescens remained relatively stable with small fluctuations(0.52％-0.60％),the detected specimens were mainly sputum(38.92％),with department of surgery(39.69％)being the most and department of gynecology and obstetrics being the least(1.55％).From 2017 to 2023,the resistance rate of S.marcescens to cefazolin was the highest(97.42％),fo-llowed by cefuroxime(71.13％),tetracycline(59.02％),cefamandole(57.47％),amoxicillin/clavulanic acid(44.59％),ampicillin/sulbactam(42.53％),cefoxitin(34.02％),chloramphenicol(15.21％),and furantoin(14.18％).The resistance rates of S.marcescens to quinolones from 2017 to 2023 were 0.52％-8.25％.Poly-myxin-resistant and tigecycline-resistant S.marcescens emerged in 2022 and 2023,respectively.Conclusion In clinical practice,antimicrobial agents should be selected rationally for the treatment of S.marcescens infection,and S.marcescens should be focused in monitoring as well as infection prevention and management,so as to prevent and control the occurrence of S.marcescens infection.

Objective:To analyze the risk factors of neonatal nosocomial infection and establish a risk prediction model.Methods:The medical records of patients in the neonatal ward of Shengjing Hospital of China Medical University in 2023 were collected and divided into infection group and non-infection group according to whether nosocomial infection occurred. Univariate analysis was used to compare the differences of related factors between two groups. Multivariate Logistic regression analysis was used to screen the independent risk factors of neonatal nosocomial infection and construct the risk prediction model. The predictive value of the model was analyzed by receiver operating characteristic curve.Results:A total of 3 487 neonates were included in the study, including 1 881 males and 1 606 females. The median gestational age was 35 (32,38) weeks, and the median birth weight was 2 470(1 760,3 200) g. There were 158 cases in infection group and 3 329 cases in non-infection group. The main types of nosocomial infection were neonatal septicemia (142 cases,85.5%), central venous catheter-related infection (13 cases, 7.8%) and respiratory tract infection (eight cases, 4.8%). The main pathogens were Klebsiella pneumoniae (50 strains, 29.8%), Escherichia coli (26 strains, 15.5%)，and Staphylococcus epidermidis (25 strains, 14.9%). The independent risk factors of neonatal nosocomial infection were low birth weight ( OR=0.999,95% CI 0.999-1.000, P=0.039), central venous catheter placement ( OR=2.122, 95% CI 1.359-3.315, P=0.001), tracheal intubation ( OR=3.241, 95% CI 1.811-5.798, P<0.001)，and parenteral nutrition ( OR=11.087,95% CI 3.696-33.258, P<0.001). The regression equation of the established risk prediction model was Logit( P) =-47.407-0.001× birth weight +0.752× central venous catheter placement +1.176× tracheal intubation +2.406× parenteral nutrition. The area under the receiver operating characteristic curve was 0.870, the sensitivity was 89.2%, and the specificity was 76.0%,respectively. Conclusion:The risk prediction model of low birth weight, central venous catheter placement, tracheal intubation and parenteral nutrition is a good predictor of neonatal nosocomial infection and has certain clinical application value.

Objective:To explore the sleep status and impact factor analysis of patients in clinical trials of antineoplastic drugs, and provide a basis for improving the sleep status and impact analysis of patients in clinical trials of antineoplastic drugs.Methods:From April to May 2023, 107 oncology patients in the Phase I Clinical Trial Ward of the Affiliated East Hospital of Tongji University were selected as the research objects by convenient sampling method. The general information questionnaire, Pittsburgh Sleep Quality Index Scale (PSQI), Numeric rating scale (NRS), Generalized Anxiety Disorder Scale (GAD-7) and Depression Self-Ration Tool Scale (PHQ-9). Multivariate Logistic regression analysis methods were used to carry out a cross-sectional investigation and the relevant factors affecting patients′sleep.Results:Totally 103 questionnaires were effectively collected. The 103 patients′ age ranged from 20 to 75 years old, including 61 males and 42 females. 47.57% (49/103) patients in clinical trials of antineoplastic drugs had abnormal sleep. The average score of patients (PSQI) (7.66 ± 3.93) was higher than the average score of the domestic norm (3.88 ± 2.52), and there was significant statistical difference ( t = 9.76, P<0.01). Logistic regression analysis showed that pain ( OR = 3.004, 95% CI 1.135-7.948, P<0.05) and trial cycle ( OR = 0.432, 95% CI 0.191-0.978, P<0.05) were significant risk factors for abnormal sleep quality. Conclusions:The incidence of abnormal sleep quality in patients of clinical trials of antineoplastic drugs is high, but the sleep quality is poor. The factors that affect the sleep quality of patients in clinical trials of antineoplastic drugs are mainly related to the patient′s trial cycle and cancer pain. According to these characteristics, individualized programs should be developed to improve the sleep quality of patients with advanced cancer, so as to improve the quality of life of patients with advanced cancer.

Objective To analyze and compare the auxiliary value and significance of γ-interferon release assay (IGRA) in the diagnosis of tuberculosis. Methods A retrospective analysis was conducted to collect the test results of 462 suspected tuberculosis patients who underwent IGRA detection in the outpatient department of Tianjin Tuberculosis Control Center from January 2020 to December 2021. According to the diagnostic results, they were divided into a tuberculosis group of 229 cases (203 cases of pulmonary tuberculosis and 26 cases of extrapulmonary tuberculosis) and a non-tuberculosis group of 233 cases. The auxiliary diagnostic value of IGRA for tuberculosis was analyzed and compared with two methods of Mycobacterium tuberculosis culture and Xpert MTB/RIF. Results The positive rates of IGRA, Mycobacterium tuberculosis culture, and Xpert MTB/RIF in TB patients were 76.42%, 29.26% and 40.62%, respectively, compared with the non-TB group (38.20%, 0.00%, 0.00%), with statistically significant differences (P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of IGRA alone in the detection of tuberculosis were 76.42%, 61.80%, 69.29%, and 72.73% respectively, those of Mycobacterium tuberculosis culture were 29.26%, 98.28%, 94.37%, and 63.43%, and those of Xpert MTB/RIF were 40.60%, 100%, 100%, and 63.14%. The positive rates of IGRA were 76.85% and 73.08% in patients with pulmonary tuberculosis and extrapulmonary tuberculosis, respectively, with no statistical significance (P>0.05). The positive rates of IGRA in bacterial positive patients and non-tuberculosis patients were 79.34% and 38.20%, respectively, with statistical significance (χ2=54.526, P<0.001). The positive rates of IGRA in patients with and without tuberculosis were 73.15% and 38.20%, respectively, with significant difference (χ2=36.456, P<0.001). Conclusions IGRA has a relatively high sensitivity in the diagnosis of tuberculosis and also has certain advantages in the screening of extrapulmonary tuberculosis and mycobacterium-negative It provides important reference basis for the clinical diagnosis of tuberculosis.

Objective To evaluate transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Data from the chnical records of 31 patients (30 female and 1 male) with IC/BPS were analyzed retrospectively.Transurethral fulguration and biopsy were performed.Intravesical instillation of heparin and alkalinized lidocaine (25 000 units of hepmin,10 mL of 2％ lidocaine,and 5 mL of 5％ sodium bicarbonate) was administered weekly for 8 weeks.Thereafter,intmvesical instillation treatment was administered twice a month.The interstitial cystitis symptom index and problem index (O'Leary-Sant index),visual analog scale score for pain,quality-of-life index,voiding frequency,bladder capacity,and side effects of intravesical instillation were recorded preoperatively and at the first and sixth month follow-ups postoperatively.Results The follow-up period was 6 to 24 months.The interstitial cystitis symptom index and problem index,visual analog scale score for pain,quality-of-life index,daily voiding time,and maximal bladder volume improved significantly in 28 cases (90.32％;P ＜ 0.01),and no significant adverse effects were observed.Two patients underwent cystectomy,and the symptoms disappeared after the operation.Carcinoma in situ was detected on histopathological examination in one patient.Conclusion Transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine is a safe and effective therapy for IC/BPS.

Objective To analyze the risk factors for ventilator-associated pneumonia(VAP) in the intensive care unit(ICU) of a hospital,and provide theoretical reference for preventing and controlling VAP.Methods ICU patients receiving mechanical ventilation for more than 48 hours between October 2013 and December 2014 were monitored by targeted monitoring method,risk factors for the occurrence of VAP were analyzed.Results A total of 483 patients received mechanical ventilation for more than 48 hours,76 (15.73％) of whom developed VAP;the overall ventilator days were 5 347 days,incidence of VAP was 14.21 per 1 000 ventilator days.Univariate analysis showed that groups of gender,age,length of hospital stay,and duration of artificial airway were all significantly different,VAP rate in male patients was higher than that in female patients(x2 =9.838,P＜0.01);VAP rate was highest in patients aged 41-70 years(x2 =10.242,P＜0.01),followed by patients aged≥71 years;VAP rate were relatively higher in patients with longer length of hospital stay and longer duration of artificial airway(x2 =59.533,P＜0.01;x2 =74.215,P＜0.01,respectively).Conclusion Incidence of VAP in the ICU of this hospital is higher,especially in male patients,patients aged 41-70 years,as well as patients with long length of hospital stay and long duration of artificial airway.

Objective To design reasonable informatization model of nursing human resource allocation and to apply it to clinical nursing so as to make nursing human resource allocation scientific and reasonable.Methods The time table was designed according to the program of direct nursing and indirect nursing. It was tested in five surgical departments between January 19th 2016 and January 23rd 2016 and five internal medicine between January 24th 2016 and January 28th 2016. The situation before and after allocation were compared with the questionnaires of quality of nursing, patients' satisfaction and nurses' satisfaction. Results The nursing human resource allocation model built with information technology could export the hours of direct nursing in real time and configure nursing staff reasonably in line with the hours of nursing. The quality of nursing, patients' satisfaction and nurses' job satisfaction after the reasonable allocation were higher than those before allocation with statistically significant differences (t=-29.646, -5.783, -2.369;P<0.05). Conclusions The nursing human resource allocation designed by the research is with real time. Besides, it can improve the quality of nursing, patients' satisfaction and nurses' job satisfaction.

Objective To observe the influence of hospital -community -family -individual 4 -level intervention model on schizophrenia patients in compliance,recurrence rate,psychotic symptom,social function,quali-ty of life and provide guidance for disease management.Methods 198 schizophrenia patients were divided into 4 -level intervention model group and conventional intervention group.After 6 moths follow -up,the effect was evaluated by compliance rate,recurrence rate,BPRS,WHO -DASII,SQLS.Results After the intervention for 6 months,the compliance,recurrence rate,the difference of severity of psychotic symptom,the difference of social function of the 4 -level intervention model group were 96.74%,13.04%,(7.57 ±2.83)points,[understanding and communication (6.32 ±3.64)points,physical exercise (5.16 ±3.28)points,self care (2.87 ±1.38)points,get on well with others (9.05 ±3.51)points,life activity (5.42 ±2.49)points,social participation (7.85 ±3.28)points],which of conven-tional intervention group were 74.74%,28.42%,(4.86 ±1.24)points,[understanding and communication (3.89 ± 1.86)points,physical exercise (2.80 ±1.238)points,self care (2.19 ±1.16)points,get on well with others (5.83 ± 3.04)points,life activity (3.41 ±1.96)points,social participation (4.27 ±2.17)points],the differences between the two groups were significant (χ2 =9.020,P =0.003;χ2 =6.932,P =0.009;t =8.527,P =0.000;t =5.775,P =0.000;t =6.554,P =0.000;t =3.652,P =0.000;t =6.712,P =0.000;t =6.144,P =0.000;t =8.829,P =0.000).The differences of before intervention and after intervention in the 4 -level intervention model group were psychological society (16.03 ±6.75)points,power and energy (15.79 ±6.41 )points,symptoms and side effects (19.37 ±7.28 )points,which in the conventional intervention group were psychological society (12.65 ± 5.46)points,power and energy (11.81 ±4.71 )points,symptoms and side effects (15.18 ±6.29 )points,the differences were statistically significant between the two groups (t =3.770,P =0.000;t =4.849,P =0.000;t =4.216,P =0.000).Conclusion Hospital -community -family -individual 4 -level intervention model has a positive effect on schizophrenia patients,which is worthy of clinical promotion.

Objective To improve hand hygiene (HH)compliance of health care workers (HCWs)in neonatal in-tensive care units(NICUs)in China through a series of intervention measures.Methods A multicenter study was conducted,17 tertiary first class hospitals in 9 provinces and cities were selected,HH compliance of HCWs in these hospitals were investigated every month according to HH investigation method of World Health Organization.From October 1 ,2013 to March 31 ,2014 was pre-intervention stage;from April 1 ,2014 to September 30,2014 was post-intervention stage,timely feedback and intensified training were conducted at post-intervention stage.Results HH compliance rates of HCWs before and after intervention were 80.29% and 80.85% respectively,there was no sig-nificant difference (P >0.05).HH compliance rates of HCWs in different sizes of ICUs were significantly different before and after intervention (all P <0.05),in NICUs with<20 beds and 20-30 beds after the intervention were both significantly higher than before intervention (both P <0.05 ),while >30 beds were significantly lower than before intervention(P <0.001 );HH compliance rate of cleaners increased from 58.82% before intervention to 68.09% after intervention (P <0.05 );Of different hand hygiene indications,except before clean/aseptic task, compliance to the other HH indications were significantly different between before and after intervention(all P <0.05).Conclusion HH compliance is high among HCWs in NICUs in China,intervention measures,such as inten-sified training and timely feedback have certain influence in compliance to HH among HCWs at different sizes of ICUs,of different occupations,and at different HH indications.