Objective: To explore the trend of detection and antimicrobial resistance of Serratia marcescens with different infection types for 7 consecutive years, to provide a reference for future studies for the control of S. marcescens infections and a rational selection of antibiotics. Methods: S. marcescens isolates were collected from 2014 to 2020, and the trend of detection and antimicrobial resistance were analyzed according to different types of infection. Results: For 7 consecutive years, the data showed that patients with S. marcescens infections were mainly from the intensive care unit (ICU) (384 isolates, 40.98%), and the isolates recovered were mainly from sputum samples (743 isolates, 79.30%). The number of isolated strains increased every year, and the average rate of detection ranged from 0.60% to 0.80%. The detection rate of S. marcescens with hospital-acquired infections (HAI) showed a downward trend and that of S. marcescens with colonization showed an upward trend. The detection rate of multidrug-resistant S. marcescens fluctuated between 8.33%–16.89%. The resistance rate of S. marcescens to piperacillin was 17.0%–29.06% and the resistance rate to piperacillin tazobactam was 2.95%–13.13%. For cephalosporin antibiotics, the resistance rates of S. marcescens to cefuroxime and cefazolin were >99% and the resistance rates to ceftazidime and cefepime were <13%. The resistance rate of S. marcescens to aminoglycoside antibiotics, especially amikacin, was the lowest. The resistance rate of S. marcescens with community-acquired infections (CAI) to carbapenems was higher than that with HAI and colonization. Conclusion: The different infection types of S. marcescens have different detection and epidemic trends. In addition, resistance to carbapenems is different across the strains.

目的 探讨急性Stanford A型主动脉夹层(AAAD)术后患者发生呼吸机相关肺炎(VAP)的危险因素,分析感染病原菌分布.方法 选取南京医科大学第一附属医院2015年4月-2020年10月行A型夹层标准术且术后使用机械通气的139例患者,根据是否出现VAP分为感染组(n=35)和非感染组(n=104),对年龄、性别、住院天数、呼吸机支持天数、使用呼吸机次数、是否行急诊手术等多项临床病例资料进行病例对照分析,探索危险因素,分析病原菌分布特点.结果 单因素分析显示高龄、长时间机械通气、频繁气管插管可能会增加术后VAP感染概率;多因素分析显示机械通气时间延长(OR=1.197,95％CI:1.102～1.299)是A型夹层标准术后发生VAP的独立危险因素.机械通气时间越长,感染风险越高,尤其是>10 d的患者,VAP发生率>70％.术后发生VAP的病原菌主要为鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌,耐药菌主要为泛耐药鲍氏不动杆菌(MDR-AB)、耐碳青霉烯铜绿假单胞菌(CR-PA)和肺炎克雷伯菌(CR-KP).结论 临床需积极采取预防措施,降低VAP感染风险,防治多药耐药菌感染,尤其尽可能缩短机械通气时间,改善预后.

Objective:To explore the effect of "four step" training mode for all staff in hospital infection control on monitoring indicators of nosocomial infection.Methods:From June 25 to September 30, 2019, the whole staff of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) were trained on the knowledge and skills of infection prevention and control by the "four step" training mode. The training contents include basic knowledge of nosocomial infection, hand hygiene, occupational exposure prevention and disposal, disinfection and sterilization, medical waste management, standardized inspection, multi drug resistant bacteria prevention and control, infectious disease management, etc. Monitoring indicators included hospital infection rate, hospital infection case rate, surgical incision infection rate, three tube infection rate of ICU patients, microbial sample submission rate before the use of therapeutic antibiotics, hand hygiene compliance and accuracy rate.Results:After the implementation of the "four step" sensing and control full staff training, the incidence of nosocomial infection in the whole hospital, internal medicine, surgery, geriatrics and ICU ward decreased (P<0.05), the infection rate of surgical site in the whole hospital decreased from 0.66% to 0.42%, and the infection rate of class I and class II surgical incision was also lower than that before the implementation of the training (P<0.05). There was no significant difference in the infection rate of class III surgical incision before and after the implementation of the training, The infection rate of three tubes in intensive care unit (ICU) patients did not change after the implementation of "four step" full staff training. The submission rates of all kinds of antibiotics, restricted antibiotics and special antibiotics in the whole hospital were improved (P<0.05), and the hand hygiene compliance and accuracy of nurses were improved (P<0.05), Although the compliance of hand hygiene was improved after the implementation of the training, there was no statistical difference in the correct rate (P>0.05).Conclusion:The "four step" training and assessment mode for all staff of infection control and prevention has a positive feedback effect on the monitoring indicators of nosocomial infection, and the level of nosocomial infection prevention and control has been significantly improved.

目的:评价肾小球滤过率(glomerular filter rate,GFR)估算公式评估获得性孤立肾(acquired solitary kidney,ASK)人群肾功能的准确性.方法:收集2009年12月-2019年5月在南京医科大学第一附属医院诊治的ASK人群为研究对象,以核素肾动态显像法测定的GFR为参考标准,纳入5个GFR估算公式:MDRD、Xiangya、CKD-EPIScr、 CKD-EPIScys C和CKD-EPIScr·Scys C公式,分别以偏倚、离散度和准确度等指标评价公式的准确性.结果:共有78例患者入选,其中肾脏捐献术后(供肾组)35例,因病切肾(非供肾组)43例.供肾组更年轻,肾功能优于非供肾组,其病程也短于非供肾组.所有公式在供肾组中的准确度均高于非供肾组.联合血清肌酐(Scr)和血清胱抑素C(Scys C)的CKD-EPIScr-Scys C在ASK人群中具有最低的偏倚和最高的准确度,并且在供肾组和非供肾组中仍具有最高的准确度.基于Scys C的CKD-EPIScys C公式的准确性高于基于Scr的CKD-EPIScr、MDRD和Xiangya公式.CKD-EPI Scys C低估GFR,而基于Scr的CKD-EPIScr、MDRD和Xiangya公式高估GFR.结论:在ASK人群中,GFR估算公式的准确性依次是联合指标公式、单纯基于Scys C的公式和单纯基于Scr的公式.相较于因病切肾的人群,估算公式在肾脏捐献术后人群中更加准确.