目的 了解某儿童医院多重耐药菌(MDRO)感染分布情况和变化趋势.方法 采取细菌分离鉴定技术和药敏试验方法,对某儿童医院2016—2018年住院患儿送检标本进行检测与分析.结果 该儿童医院2016—2018年MDRO检出率依次为20.72％、14.42％和8.98％,有逐年下降趋势.耐甲氧西林金黄色葡萄球菌(MRSA)占比逐年上升,产超广谱β-内酰胺酶(ESBL)肠杆科细菌占比逐年下降,而耐碳青酶烯类肠杆科细菌(CRE)占比先上升、后下降.MDRO感染病例中大部分为社区感染,4.7％～5.7％为医院感染.MDRO发现率最高的科室依次为重症医学科、心胸外科、新生儿外科和新生儿内科.MDRO的标本主要是痰液和分泌物,其次为尿液和血液.结论 该儿童医院MDRO菌谱不断迁移,针对MDRO感染分布情况和变化趋势,加强耐药菌株监测和抗菌药物监管,对于降低儿童MDRO感染有重要意义.

目的:评价联合新型冠状病毒(SARS-CoV-2)特异性IgM和IgG抗体诊断新型冠状病毒感染的价值.方法:检索Pubmed、CNKI、维普、万方等数据库,检索时间为建库至2020年3月27日发表的文献,收集关于联合SARS-CoV-2特异性IgM和IgG抗体诊断新型冠状病毒感染的相关文献并进行Meta分析;使用MetaDisc 1.4软件进行Meta分析;计算敏感度、特异度、似然比及受试者工作特征曲线(SROC曲线)等统计指标,综合评价联合SARS-CoV-2特异性IgM和IgG抗体对新型冠状病毒感染的诊断价值,并进行亚组分析与Meta回归分析.结果:共纳入9篇文献包含11个数据集,中文文献8篇,英文文献1篇,总样本量为2 249,合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比分别为0.89(0.87～0.90)、0.95(0.94～0.97)、16.62(12.39～22.29)、0.11(0.08～0.17)、200.49(129.84～309.59),SROC曲线下面积(AUC)为0.978 9.亚组分析和Meta回归分析显示感染阶段、检测方法、研究地区、病例数可能是异质性的来源(P＜0.1).SARS-CoV-2特异性IgM/IgG抗体对感染早期的诊断准确性低于感染早中期和中后期,抗体测定方法中化学发光法较胶体金法诊断准确性高,不同地区和不同病例数的研究诊断准确性有差异.结论:联合SARS-CoV-2特异性IgM和IgG抗体诊断新型冠状病毒感染有较高的诊断价值.其中特异性高,可用于复工复学人群的筛查,化学发光法较胶体金法诊断准确性高,在感染早期,单独使用特异性IgM和IgG抗体存在一定的漏诊风险,需与核酸联合检查,提高感染诊断的准确性.

目的 探讨新生儿耐碳青霉烯类肠杆菌(CRE)感染的危险因素,为新生儿CRE感染防控和抗菌药物合理使用提供依据.方法 选择武汉儿童医院新生儿病区2016—2018年CRE感染新生儿68例(CRE组),随机选取同期同病房碳青霉烯类敏感肠杆菌(CSE)感染新生儿50例(CSE组),进行回顾性病例对照研究,分析CRE感染的危险因素.结果 CRE组新生儿68例,其中肺炎克雷伯菌感染60例(88.24％),大肠埃希菌感染7例(10.29％),产酸肺炎克雷伯菌感染1例(1.47％).CRE组医院感染38例(55.88％),CSE组医院感染6例(12.00％),两组比较差异有统计学意义(P<0.05).两组新生儿均以下呼吸道感染为主.单因素分析显示,小胎龄、低出生体重、新生儿呼吸窘迫综合征、气管插管、机械通气时间、PICC置管、抗菌药物使用时间、抗菌药物使用种类≥3种、碳青霉烯类药物使用史、糖皮质激素使用史、住院时间长均为新生儿感染CRE的危险因素.多因素回归分析显示,低出生体重、机械通气日数、碳青霉烯类药物使用史为CRE感染的独立危险因素.结论 新生儿CRE感染以医院感染为主,应针对新生儿CRE感染危险因素制定综合性防控措施,以减少CRE感染的发生和传播.

目的 探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患儿心肌损害的影响因素,为临床早期诊治提供参考.方法 选取2017年1月-2018年12月于湖北省武汉儿童医院心内科住院的MPP患儿258例,进行回顾性研究,根据是否发生心肌损害分为心肌损害组(n=54)和非心肌损害组(n=204),比较两组一般临床资料及实验室指标的差异,并采用多因素Logistic回归分析筛选M PP患儿心肌损害的影响因素.结果 心肌损害组高热、发热持续时间>7d、大环内酯类抗菌药物使用起始时间>7d、合并其他肺外并发症比例及肺炎支原体(Mycoplasma pneumonia,MP)抗体滴度>1:80、N-末端脑钠肽前体N-terminal-proBNP,NT-proB-NP)、C-反应蛋白(C-reactive protein,CRP)、缺血修饰白蛋白(Ischemic modified albumin,IMA)、红细胞分布宽度(red blood cell distribution width,RDW)水平均高于非心肌损害组(P<0.05).多因素Logistic回归分析结果显示,发热程度、发热持续时间、大环内酯类抗菌药物使用起始时间、CRP、IM A、RDW是M PP患儿并发心肌损害的危险因素(P<0.05).结论 MPP患儿治疗期间应行心脏标志物检查及心电图检查,结合这些因素有助于早期发现心肌损害并及时干预.

目的 分析儿童新型冠状病毒感染肺炎(Corona virus disease,COVID-19)确诊病例临床和流行病学特征,为制定儿童新型冠状病毒肺炎疫情防控策略和措施提供科学依据.方法 采用回顾性的单一中心研究,对2020年1月25日-2月18日武汉儿童医院收治的91例新型冠状病毒肺炎确诊病例的临床资料及流行病学资料进行总结分析.结果 91例COVID-19确诊患儿中男56例(61.54％)、女35例(38.46％),年龄中位数为4岁,16例(17.58％)有其他疾病或感染其他病原体;72例(79.12％)与家庭成员中有C O V ID-19疑似或确诊患者有过接触史.临床分型为轻症53例(58.24％),其中无症状感染者7例(7.69％)、普通型31例(34.07％)、重型6例(6.59％)、危重型1例(1.10％).最主要的临床表现为发热(56例、61.54％)、咳嗽(51例、56.04％)、乏力(14例、15.38％),腹泻等胃肠道症状较少.11例(12.09％)患儿胸部C T影像学检查表现为斑片状或磨玻璃影,12例(13.19％)患儿表现为单侧肺炎,11例(12.09％)患儿表现为双侧肺炎.33例(36.26％)患者乳酸脱氢酶异常,32例(35.16％)患者C-反应蛋白异常,54例(59.34％)患儿降钙素原异常.新型冠状病毒首次检测核酸阳性至连续(间隔1天)两次转阴性患儿73例(80.22％),中位数为7天.结论 病例以男童为主;1～12岁为高发人群;儿童患者临床症状以发热和咳嗽为主,大多数患儿为轻症;多数患儿与新型冠状病毒肺炎确诊或疑似患者有密切接触史,且多数为家庭聚集性发病.

目的 探讨武汉地区儿童肠道病毒的流行病学特征及不同核型肠道病毒感染患儿的临床特征和实验室指标差异,为制定肠道病毒诊疗和防控策略提供依据.方法 采集2016-2018年武汉市两家哨点医院(武汉儿童医院、湖北省妇女儿童中心)疑似肠道病毒感染患儿8 580例的咽拭子或肛拭子,通过逆转录-聚合酶链反应(Reverse transcription-polymerase chain reaction,RT-PC R)技术进行肠道病毒核酸检测及分型,同时收集患儿的基本信息和临床资料,分析其流行趋势、临床症状、感染指标[白细胞计数(WBC)、中性粒细胞(NEU)、淋巴细胞(LYM)、C-反应蛋白(CRP)、降钙素原(PCT)]、淋巴细胞(CD3+、CD3+ CD4、CD3+ CD8+、CD4+/CD8+)及免疫指标[免疫球蛋白A (IgA)、IgM、IgG、补体C3、C4]等特征.结果 2016-2018年共检出肠道病毒(Enterovirus,EV)阳性884例,阳性率为10.30％ (884/8580).2017年阳性率最高,不同年份阳性率差异有统计学意义(P=0.001).EV感染具有明显的季节性,5-7月达到高峰,10月又出现一个小高峰.93.33％ (825/884)的阳性病例为6岁以内患儿.不同核型的肠道病毒感染的患者除肢体抖动外,其他症状差异无统计学意义,不同核型EV感染患者CRP、CD3+、CD3+ CD4+T淋巴细胞百分比、补体C3、C4等指标差异有统计学意义(P＜0.05).重症病例患者更易发生高热、腹泻、肢体抖动、呼吸异常、心率增快等症状.重症患儿WBC、NEU、CRP、免疫标记物IgA、IgG、补体C3、C4分别为(12.44±3.92)×109/L、(8.58±8.02)×109/L、(6.69±8.47)mg/L、(1.01±0.79)g/L、(8.41±2.46)g/L、(1.05±0.37)g/L、(0 59±2.01)g/L均高于轻症患儿(P＜0.05),而CD3+、CD3+ CD4+分别为(40.81±8.18)％、(18.12±6.72)％低于轻症患儿(P＜0.001).结论 武汉地区肠道病毒的流行核型已逐渐发生变化,2017、2018年其他肠道病毒基因型已经取代EV-71、Cox A-16成为优势核型.我国仍需继续开展肠道病毒的日常和哨点监测工作,并进一步加强对其他核型的检测,密切关注核型的变化,为提供有针对性的防控与治疗措施提供依据.同时针对其他核型的肠道病毒疫苗的研发工作也刻不容缓.重症病例易引发患者机体免疫功能紊乱,应及早采取干预措施.

目的 为确保消化内镜消毒时邻苯二甲醛的消毒效果,探索该消毒剂合理的更换频率.方法 分别监测邻苯二甲醛使用中的浓度、染菌量和消毒后消化内镜微生物学指标,通过初步及确证试验,确定邻苯二甲醛有效使用频数.结果 邻苯二甲醛用于胃镜消毒时有效频数为102次,用于肠镜消毒时有效频数为85次.结论 将使用时间与使用频率作为更换邻苯二甲醛的依据更具科学性,且临床实践操作性较强.

目的 了解儿科重症监护病房(PICU)医院感染的发生特点,为制定预防措施提供依据.方法 对某儿童医院PICU 2015-2016年住院患儿进行目标性监测和分析.结果 共监测患儿2921例,医院感染率及例次感染率分别为1.78％和1.95％;2016年医院感染发生率和例次感染率分别为1.35％和1.47％,均明显低于2015年的感染率(2.33％)和例次感染率(2.56％).2015年及2016年医院感染均以下呼吸道感染最常见,其次为口腔及胃肠道感染;呼吸机、中央导管及导尿管使用率分别为14.26％、20.92％和9.16％;呼吸机相关肺炎、中央导管相关血流感染及导尿管相关尿路感染发生率分别为6.20‰、0.50‰和0.57‰.2015年共检出病原菌18株,肺炎克雷伯菌最常见(50.0％),其次为铜绿假单胞菌(33.3％),2016年检出病原菌13株,仍以肺炎克雷伯菌最常见(46.1％),其次为白假丝酵母菌(30.8％).结论 PICU医院感染以下呼吸道感染最常见,器械相关感染以呼吸机相关肺炎为主,真菌感染增多,需加强重点部位的感染管理及抗菌药物的合理使用.

Objective:To investigate the role of YKL-40 in the pathogenesis of Kawasaki disease (KD) and itsrelationship with coronary artery lesions (CAL).Method:The 86 children with KD were enrolled and divided intotwo groups:72 cases of KD without CAL and 14 cases of KD with CAL.Another 40 children with upper respiratory tract infection and fever who were hospitalized during the same period were randomly selected as the controlgroup.Then we compared the levels of serum YKL-40,white blood cell(WBC),platelet(PLT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),fibrinogen (FIB) in three groups.Result:the levels of YKL-40,WBC,PLT,CRP,ESR and FIB in the KD group without CAL were significantly higher than those in the controlgroup,and the differences were statistically significant (P＜0.01).The serum YKL 40 level of KD group withCAL was significantly higher than that of KD group without CAL,the differences statistically significant (P＜0.01),while the levels of WBC,PLT,CRP,ESR and FIB were not significantly different between the twogroups (P＞0.05).Conclusion:YKL-40 plays an important role in the pathogenesis of KD and is used as a newpredictor of coronary artery lesions in patients with KD.

Objective To investigate the current status of nosocomial infection in a children's hospital,so as to provide scientific basis for prevention of nosocomial infection.Methods The prevalence rate of nosocomial infection among children who hospitalized in a children's hospital was investigated by cross-sectional method on September 1,2016.Results A total of 1 020 hospitalized children were investigated,15 patients developed 16 times of nosocomial infection,the prevalence rate and prevalence case rate of nosocomial infection were 1.47％ and 1.57％ respectively.The department with the highest prevalence rate was the department of hematology and oncology (9.09％),followed by the department of integrated traditional chinese and western medicine (4.17％) and ICU (3.70％).The main infection sites were respiratory tract (43.75％) and intestines (25.00％).The rate of antimicrobial agents usage was 60.10％.The submission rate of pathogens before using antimicrobial agents was 69.49％.Conclusion The department with the highest prevalence rate was the department of hematology and oncology.The rate of antimicrobial agents usage was a little high,It is necessary to strengthen the management of nosocomial infection of key departments.

Objective:To make a preliminary study on ECG risk stratification indexes of early repolarization pattern in children,and to improve the understanding of cardiovascular prognosis of early repolarization pattern in children.Method:A total of 128 children with early repolarization pattern were enrolled.ECG risk stratification indexes included early repolarization pattern distribution of lead,J wave morphology,J wave amplitude and ST segment shape,duration of J wave,J-wave/R-wave (J/R) ratio in the same leads,T-wave/R-wave (T/R) ratio in leads Ⅱ and V5 were analyzed.The indexes between male and female patients were compared.Result:There were 70 male and 58 female.Age ranged from 3 months to 14 years and 6 months with an average of (5.3±3.5) years.Early repolarization pattern was present in 47 subjects (36.7 ％)of the inferior leads,51 subjects (39.8％)of the lateral leads,and 30 subjects (23.4％)of the both leads.The amplitude of J wave was less than 0.2 mV in 104 subjects (81.2％),more than 0.2 mV in 24 subjects (18.8％).The distribution of J wave morphology was slurring in 76 subjects (59.4％),notching in 52 subjects(40.6％).The distribution of ST segments was rapidly ascending in 102 subjects (79.7 ％),horizontal/descending in 26 subjects (20.3％).The J/R ratio was (14.7 ± 11.3)％.The T/R ratio in leads Ⅱ and V5 was (34.5±15.3)％.J wave duration was greater than 60 ms in 2 cases.These indexes were not significant different between male and female patients.Conclusion:In children,the distribution of early repolarization pattern in inferior and lateral leads is similar,wide distribution is rare,most of J wave amplitude is less than 0.2 mV,slurring is more than notching,the ST segment after J wave is usually ascending,most of the duration of J wave is less than 60 ms.There is no significant difference between the two genders.Early repolarization pattern in children is usually considered as benign ECG variation,but the long-term cardiovascular prognosis is not clear.

Objective To explore application of the ATP bioluminescence detection in management of hospital infections. Methods ATP biological fluorescence detection method was used to do routine detection and special detection when emer-gency public health events happens of the equipment,material surface and hand hygiene,and the results from January 2014 to December were collected. Evaluate the effect of ATP bioluminescence detection on the base of passing rate in different months and different position. Results After using ATP bioluminescence detection method in management process,the av-erage passing rate raised from 33. 33% in January to 80. 76% in December,and there was an obvious trend of improvement in cleaning effect with the Pearson correlation coefficient was 0. 864(P<0. 01). Conclusion ATP bioluminescence detec-tion can significantly improve the efficiency of hospital infection management.

目的：比较三种清洗方法对医疗器械的清洗效果。方法采样ATP生物荧光法，对三种清洗方法清洗剖宫产术后医疗器械的效果进行评价。结果手工清洗法合格率为74.21%，手工＋机械清洗法合格率为96.05%，机械清洗法合格率为70.00%。结论使用后剖宫产手术器械需要在手工清洗的基础上，再用机械清洗法效果最好。

目的 研究不同预处理方式及不同放置时间对器械清洗效果的影响,以明确最佳预处理方法.方法 运用ATP生物荧光法,对剖宫产术后的器械预处理及其放置时间的影响进行了对比观察和评价.结果 设计直接放置、预冲洗、喷水保湿、喷酶保湿、多酶溶液浸泡等5个预处理组,每组处理使用后器械456件,共计2 280件.以预冲洗组和多酶溶液浸泡组的清洗合格率最高,放置时间以不超过2h为宜.结论 使用后污染器械最佳预处理方法是用后立即冲洗,用多酶洗液浸泡保湿在2h内进行清洗效果最佳.

目的 了解儿童医院住院患儿多重耐药菌的感染现状及临床分布,为有效预防与控制多重耐药菌感染提供依据.方法 采取细菌分离鉴定技术和药敏试验方法,对某儿童医院2013年度住院患儿送检标本进行检测与分析.结果 在2013年度,该儿童医院共送检病原学标本55 450份,检出多重耐药菌1 063株,检出率1.92％.多重耐药菌中,以产超广谱β-内酰胺酶大肠埃希菌比例最高,占42.43％;其次是肺炎克雷伯菌,占17.31％.多重耐药菌感染病例主要分布在儿童重症监护病房和新生儿内外科等.结论 该医院住院患儿发生多重耐药菌感染率较高,且以产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌为主,提示应加强耐药菌株监测和抗菌药物监管.

Objective This study was to determine the incidence and risk factors of ventilator-associated pneumonia(VAP) in a pediatric intensive care unit(PICU). Methods 180 patients with mechanical ventilation for more than 48 hours in the PICU were studied by targeted surveillance. Patients were divided into VAP group and non-VAP group. Potential risk factors for VAP were analyzed with univariate analysis and multivariate logistic regression analysis. Results The incidence of VAP was 13.3%(24/180). Univariate analysis showed that basic diseases, malnutrition and long intubation time(≥7days) were risk factors for VAP. Multivariate logistic regression analysis showed that malnutrition(OR=3.048, P=0.034) and long intubation time(OR=9.281, P=0.004) were independent risk factors for VAP, but basic diseases was not. Conclusion Patients receiving mechanical ventilation in PICU have a high incidence of VAP. There were some risk factors for VAP, and comprehensive prevention measures should be taken to prevent the occurrence of VAP.

Objective To investigate multi-drug resistant infection status of hospital inpatient,and provide reference for prevention and control of outbreaks of multi-drug resistant infections. Methods Targeted surveillance was used to monitor and analyze nosocomial infection of multi-drug resistant. Results The total number of patients was 57 600 in 2012 of our hospital,the patients infected by multi-drug resistant bacteria were 1 120,and the infection rate was 1. 94%. 1 120 strains of bacteria including β-lactamase producing Escherichia coli and Klebsiella pneumoniae,methicillin-resistant Staphylococcus aureus( MRSA),multidrug-resistant Acinetobacter baumannii( MDR-AB),multi-drug resistant Pseudomonas aeruginosa( MDR-PA) and other multi-drug resistant bacteria were detected in all samples. Combined with targeted surveillance identified problems and take effective prevention and control measures,two cases of suspected outbreaks of multi-resistant hospital infection was promptly controlled. Conclusion We can found problems and take control measures prmptly through the targeted surveillance of nosocomial infection,which has prospective significance.

目的 了解医院消毒与灭菌效果状况,分析存在问题,为加强医院感染与消毒管理提供参考.方法 通过回顾性调查方法,对某医院消毒管理和消毒灭菌质量状况进行监测与分析.结果 常规监测成本明显高于特殊情况监测,并逐年增加;常规监测阳性率明显低于特殊情况监测.常规监测中医务人员手、紫外线等和使用中消毒剂阳性率较高;特殊情况监测中物体表面、医务人员手、消毒器械阳性率较高.结论 常规卫生消毒监测费用较高,其监测标本阳性率与医院感染率之间相关性不明确.

目的 通过对一起新生儿伦敦沙门菌感染事件进行调查与分析,总结预防控制经验,为防止该类事件的发生提供依据.方法 于2011年12月29日-2012年1月13日调查新生儿内科108例患儿临床资料,采取现况调查与回顾性调查相结合的方法,对该次事件中的感染病例进行流行病学调查和环境卫生学监测,并分析存在的危险因素.结果 该次事件共持续16 d,调查病例108例,发现感染病例33例,罹患率为30.56％,时间分布呈现细菌性食源性疾病的流行特点,空间分布有聚集性,环境卫生学监测结果显示污染的环境和手是造成沙门菌属感染传播的重要途径,暴露于ICU、食用早产儿奶、接触护理人员是危险因素.结论 此次腹泻事件是一起由细菌性食源性疾病引起的疑似感染暴发事件,通过采取综合防控措施该事件得到有效控制.