目的 了解全国各级妇幼保健机构医院感染管理体系建设现况,为加强妇幼保健机构的医院感染管理工作提供政策依据.方法 从8个省/市/自治区的省部级、地市级和区县级妇幼保健机构中分层抽样,设计统一的调查问卷,以"问卷星"的形式开展线上调查.结果 共123所妇幼保健机构的数据纳入统计分析,其中97.56％的妇幼保健机构设立了医院感染管理委员会,98.33％的医院感染管理委员会每年至少召开两次感染监控专题会议;87.81％的妇幼保健机构设立了独立的医院感染管理部门,该部门92.68％由院长或副院长直接领导;90.24％妇幼保健机构的病区设立了临床医院感染管理小组.医院感染管理专职人员数量符合要求的妇幼保健机构占比52.03％,专职人员数量和专业结构均符合要求的比率仅为11.38％.纳入调查的12项医院感染管理制度中有9项在妇幼保健机构中建立的比率超过90％.结论 全国各级妇幼保健机构普遍建立了较为完善的组织架构和医院感染管理制度,但医院感染管理专职人员队伍建设有待加强.

耐药菌的传播严重威胁人类健康,目前耐药问题日益加剧,给医疗卫生造成极大负担.加强耐药菌感染的预防、控制和诊疗能力建设是医疗机构防控耐药菌感染传播的重要内容.本共识分析当前临床重要耐药菌的流行病学、耐药机制及实验室检测现状,并提出耐药菌感染传播防控的专家推荐意见,旨在提高防控意识,规范临床重要耐药菌感染传播防控策略,明确防控流程.

为更好地防控新型冠状病毒(2019-nCoV)医院感染,保障医疗机构医务人员及其他工作人员的安全,合理使用个人防护用品,中华预防医学会医院感染控制分会、中国医院协会医院感染管理专业委员会、中国感染控制杂志编辑委员会组织国内专家(包括赴武汉抗疫一线的部分专家)共同制定本共识.本共识主要适用于同时收治新冠肺炎患者和普通患者的医疗机构;指导疫情期间医疗机构一线医务人员合理有效利用防护用品,同时也覆盖了几乎所有非一线医务人员及其他工作人员的防护用品使用.本共识通过评估医疗机构工作人员新冠肺炎暴露的风险,根据暴露风险来确定不同区域不同岗位工作人员的个人防护标准.本共识主要内容还包括:个人防护用品介绍及适用范围,三级防护穿脱流程,个人防护用品异常的防范与应急处理,新型冠状病毒肺炎职业暴露处置流程.同时,本共识特别强调,要合理进行新冠疫情期间医疗机构区域划分,以及重点分诊岗位安排有经验的感染科或呼吸科医生参与分诊,这些是风险评估的前提要求;在选择个人防护用品时,既要防止防护不足,又要避免滥用与过度使用,以保障工作人员安全为前提,预防新冠肺炎医院感染.

Objective: The aims of this study were to analyze the clinical characteristics and treatment outcomes of such special group, and to explore possible mechanisms. Methods: A retrospective cohort including 326 antiviral treatment-naive CHB patients with concurrent HBeAg/Anti-HBe were studied. Clinical and laboratory data were collected. An improved 5 mol/L urea elution method was used for in vitro HBeAg and anti-HBe binding experiments. Results: Of the 326 patients, mean titers of HBeAg, anti-HBe were 1.48 +/- 2.85 PEIU/mL and 0.53 +/- 0.29 S/CO3 respectively. The mean level of ALT was 213.91 +/- 398.38 U/L. At week 48, the treated group achieved higher ALT normalization rate, undetectable HBV DNA rate, HBeAg seroconversion rate, and HBsAg seroclearance rate (84.8% vs 23.6%; 46.1% vs 8.7%; 6.1% vs 0.6%; and 72.1% vs 19.3%, all P < 0.05). Sub-group analysis was carried out in the treated group: 64.3% and 14.3% patients achieved HBeAg seroconversion and HBsAg seroclearance in PEG-IFN a-2a group, both significantly higher than NAs group (P = 0.006 & P = 0.010). The mean affinity index of the concurrent patients was significantly lower than the HBeAg(-)/Anti-HBe(+) patients (95.42 +/- 36.26 vs 122.10 +/- 46.10, P < 0.001). Conclusions: The prevalence of concurrent HBeAg/anti-HBe detection is often accompanied by a high level of ALT, and to effectively suppress viral replication and achieve HBeAg seroconversion, Peg-IFN is preferred. In addition, decreased affinity between HBeAg and anti-HBe is a probably explanation.

Objective To study the effect of relatively closed environment dispensing mode on insoluble particles in pharmaceuticals.Methods The numbers of insoluble particles in conventional manual dispensing mode and relatively closed environment dispensing mode in lass Ⅰ and class Ⅲ environment were detected, effect of different dispensing modes on the number of insoluble particles in pharmaceuticals was compared.Results When adopting manual dispensing, the numbers of 1-10 μm insoluble particulates in different groups in class Ⅰ environment were less than those in class Ⅲ environment respectively, differences were all statistically significant (all P＜0.05). When adopting a new mode of dispensing in relatively closed environment, there was no significant difference in the numbers of 1-15 μm insoluble particulates in different groups between class Ⅰ and class Ⅲ environment respectively (all P＞0.05). The numbers of 1-20 μm and 1-15 μm insoluble particles in different groups were less than those in manual dispensing when the new mode of dispensing were adopted in class Ⅲ and class Ⅰenvironment respectively, differences were all statistically significant (all P＜0.05). The numbers of 1-15 μm insoluble particles in different groups in manual dispensing in class Ⅰ environment were more than those in class Ⅲ environment respectively, difference were all statistically significant (all P＜0.05).Conclusion The relatively closed environment dispensing mode can effectively reduce environmental particulates entering intravenous infusion system during dispensing process.

据世界卫生组织(WHO)的数据显示,全球每年有20％～30％的儿童罹患季节性流行性感冒(简称流感),在高流行季节,儿童流感年感染率可高达50％左右,其中5～9岁儿童感染率最高,5岁以下儿童流感相关住院率最高,重症和死亡病例常发生在2岁以下儿童.美国儿科学会(AAP)已连续数年修订了《儿童流感的预防与控制建议》方案,重点针对流感预防、疫苗使用、抗病毒药物应用提出建议,并指出接种疫苗是预防流感的最佳预防措施.本文通过解读AAP感染性疾病委员会制定的《儿童流感的预防与控制建议(2018—2019年)》的重点内容,主要包括:更新的三价(包含甲型流感病毒中的H1N1、H3N2及乙型流感病毒中的Victoria系)或四价(增加乙型流感病毒中的Yamagata系)灭活疫苗(IIV)作为2018—2019年流感流行季节儿童疫苗接种的首选;抗病毒药物对控制流感很重要,其可作为流感预防的重要辅助手段,但不能替代流感疫苗的接种;流感患儿或有高危因素的疑似流感儿童建议尽早使用抗病毒药物.旨在指导全科医生、其他医疗卫生工作者在流感流行季节到来之前以及流感流行期间儿童疫苗的接种.

目的 对南方医科大学南方医院的细菌耐药性进行连续监测和报告,及时了解该院临床常用抗生素的耐药率及其发展动态趋势.方法 纳入该院2013—2017年临床分离菌株,分析其检出率、标本来源、科室分布情况、抗菌药物耐药性及对碳青霉烯类抗菌药物耐药性的变化趋势.结果 5年临床分离菌共25731株,革兰阴性菌12097株(47.0％),革兰阳性菌13634株(53.0％).其中最常见的菌种依次为:大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌等.检出标本主要来源于呼吸道(痰、咽拭子等)33.88％、分泌物20.40％、中段尿19.19％;主要集中在神经内科17.71％、神经外科14.25％ 和呼吸内科9.71％.送检标本中产超广谱 β-内酰胺酶(ESBLs)大肠埃希菌和产ESBLs肺炎克雷伯菌检出率呈逐年上升趋势,差异有统计学意义(χ2=11.171,P=0.025;χ2=28.797,P<0.001).此外,肺炎克雷伯菌对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药性亦呈逐年上升趋势.结论 该院大肠埃希菌及肺炎克雷伯菌的耐药性整体呈上升趋势,其中耐碳青霉烯类及产ESBLs的菌株检出率上升较为明显,应提高临床合理使用抗菌药物的水平,加强细菌耐药监测,避免耐药菌在院内流行或泛滥.

目的 利用秀丽隐杆线虫-肺炎克雷伯菌感染模型,探讨白藜芦醇对肺炎克雷伯菌致病性影响.方法 取同期化处理后的L4期线虫,经肺炎克雷伯菌感染5d后,洗涤、离心,转移至96孔板内(10只/孔),每孔加入LB溶液40μl、M9缓冲液160μ1、FUDR及不同浓度的白藜芦醇,每组5个复孔,20℃静置培养.实验组加入不同浓度的白藜芦醇(0,0.1,0.2,0.4,0.8mg/ml),空白对照组L4期线虫经大肠埃希菌OP50喂养5d后转移至96孔板内,不加白藜芦醇;每24h观察线虫生存情况.结果 经Log Rank检验法进行组间差异比较发现,与0mg/ml白藜芦醇比较,0.2,0.4,0.8mg/ml浓度对线虫生存时间的影响有统计学差异(P＜0.05,x2值分别为29.262,35.148,37.040);0.1mg/ml浓度的白藜芦醇对线虫生存时间的影响无统计学差异(P ＞0.05,x2=0.05);同时采用Log Rank检验法对0.2,0.4,0.8mg/ml三组浓度白藜芦醇对感染后线虫生存时间进行组间比较发现,该三组对线虫生存时间的影响无统计学差异(P ＞0.05,x2值分别为0.05,0.25,0.56).结论 在秀丽隐杆线虫-肺炎克雷伯菌感染模型中,高浓度白藜芦醇能使感染后线虫生存时间延长,但随着浓度的增加,对线虫生存时间并无明显影响.

目的:通过分析手术部位感染病例与疾病诊断相关分组(DRGs)的关联性,旨在有针对性地采取干预措施,降低医院感染的发生率.方法:分析某医院的手术部位感染病例DRGs的集中趋势,并利用病例组合指数(CMI)进行风险调整,使疾病严重程度不同的病例组之间具有可比性.应用x2检验对各科室间的手术部位感染率以及各科室不同DRGs间手术部位感染率进行比较分析.结果:排名前5位科室感染例数占总感染数的73.7％,取手术部位感染患者数在2例及以上的DRGs进行分析,96例感染患者主要集中在22个DRGs,占199例感染患者的48.24％.除神经外科外,其他科室中不同DRGs的风险调整后感染率之间均有统计学差异(P<0.05).单位CMI感染率最高的组别为:普外科GF13(7.72％)、肝胆外科HD33(8.44％)、创伤骨科ID23(8.30％)、脊柱骨科IB13(1.28％).结论:手术患者医院感染在DRGs中具有集中趋势,可通过对手术部位感染集中的DRGs进行根因分析,有针对性地干预,降低医院感染的发生.

Objective To understand the direct economic burden of healthcare-associated infection(HAI)due to multidrug-resistant organisms(MDROs).Methods Computer retrieval of CNKI,Wanfang,VIP,PubMed,Sci-enceDirect,and Cochrane databases on literatures about economic burden of MDRO HAI at home and abroad were performed,the retrieval time was from database establishment to December 2015,systematic evaluation of the liter-atures was obtained.Results According to the inclusion and exclusion criteria,as well as through Newcastle-Otta-wa Scale (NOS)for evaluating the literatures,19 literatures were included.In 12 studies about methicillin-resistant Staphylococcusaureus infection,the direct economic cost varied from $916.61 to $62908.00;in 4 studies about MDRO Acinetobacterbaumannii infection,the direct economic cost varied from$4644.00 to $98575.00.Direct economic cost due to extended-spectrumβ-lactamases-producing Enterobacteriaceae was $2824.14-$30093.00. Conclusion MDRO HAI will increase economic cost of both hospitals and patients,prevention and control measures should be taken .

目的 采用线虫液体培养法,建立秀丽隐杆线虫-多重耐药鲍曼不动杆菌(multidrug resistance acinetobacter baumannii,MDRAB)感染模型.方法 利用临床分离的MDRAB对线虫进行感染,通过考察线虫的存活率,探讨感染线虫模型所需的细菌浓度;感染后取不同时间点将感染线虫裂解,对上清液进行线虫肠道细菌鉴定及菌量计数,以验证模型的成功建立.结果 细菌浓度在1.20×109cfu/mL 的MDRAB组线虫的生存率明显低于E.coli OP50及空白对照组,差异有统计学意义(X2=112.75,P<0.001).实验所得上清液经细菌鉴定及药敏测试证实为MDRAB;MDRAB感染线虫4、8、12、24 h后,线虫体内菌量分别为(0.22±0.02)×105、(0.54±0.03)×105、(1.69±0.02)×105、(3.22±0.60)×105cfu/mL,采用One-Way ANOVA分析,不同时间点感染线虫肠道内菌量差异有统计学意义(F=27.32,P<0.001).结论 本实验成功建立了秀丽隐杆线虫-多重耐药鲍曼不动杆菌液体感染模型.

Objective To establish an infection model using Caenorhabditis elegans (C.elegans)-extensively drug-resistant Klebsiella pneumoniae (XDRKP)system.Methods Clinically isolated XDRKP strains were used to infect C.elegans in the liquid killing assay,the nematode survival and the number of bacteria in C.elegans digestive tract was observed.Results C.elegans was significantly retarded after being infected by XDRKP,different concentra-tions of XDRKP led to different patterns of the worm death.Log-rank test showed that survival curves of C. elegans infected with 1 .5×106 CFU/mL of XDRKP and E.coli OP50 (control)were not significantly different (χ2 =0.08,P >0.05);survival curves of C.elegans infected with 1 .5 ×107 CFU/mL,1 .5 ×108 CFU/mL of XDRKP and E.coli OP50 were significantly different(χ2 =229.37,275.98,respectively,both P <0.001).The survival rates of 1 .5×108 and 1 .5 ×107 CFU/mL XDRKP groups were both lower than that of the control group.Supernatant suspension obtained from test was performed bacterial culture,identification and antimicrobial susceptibility testing, XDRKP was determined.After being infected with XDRKP 4,6,12,and 24 hours,the total number of bacteria in C.elegans were(0.28±0.02)×105 CFU/mL,(0.50 ±0.38)×105 CFU/mL,(1 .73 ±0.56)×105 CFU/mL,and (2.62±0.53)×105 CFU/mL,respectively,the number of bacteria in C.elegans digestive tract was significantly different at different time points (F =1 363.39,P <0.001).Conclusion The infection model of C.elegans-XDRKP is established successfully.

Objective To explore the main sites,pathogen distribution and risk factors of healthcare-associated in-fections (HAI)in children with acute leukemia,and provide scientific evidence for prevention and treatment. Methods Data of 828 children with acute leukemia admitted to a hospital in 2011 -2012 were collected,infection site,pathogen distribution and risk factors of infection were analyzed.Results Of 828 patients,184 cases and 196 times of HAI occurred with the incidence of 22.22% and 23.67%,respectively.HAI occurred mostly in respiratory tract (52.56%).A total of 96 pathogenic strains were isolated,among which gram-negative and gram-positive bac-teria accounted for 58.33%(n=56)and 29.17%(n=28)respectively.Univariate analysis revealed that risk factors for HAI were leukemia remission induction chemotherapy,hospital stay ≥ 30 days,peripheral leukocyte count (WBC)≤3×109/L,granulocyte count ≤0.5 ×109/L,and acute nonlymphocytic leukemia.Multivariate analysis revealed that hospital stay ≥30 days was independent risk factors for HAI.Conclusion Children with acute leuke-mia have a high incidence of HAI,infection mainly occurs in respiratory system,and gram-negative bacteria are ma-jor pathogens.The incidence of HAI is correlated with remission induction chemotherapy,long length of hospital stay,low WBC,low number of neutrophils,and acute myeloid leukemia.

The importance of multidrug-resistant organisms (MDRO) in Chinese hospitals is not clearly delineated. Thus we sought to assess the prevalence of MDRO in Chinese intensive care units (ICUs).

Children with hematological diseases usually accompanied by low autoimmune function,and repeated chemotherapy exacerbated the damage to their immune system and hematopoietic function.Those lead to high incidence of nosocomial infection,most of infection were caused by multi-drug resistant bacteria and fungi.The major infections in hematological children are the following:multi-drug resistant Escherichia coli/Klebsiella pneumonia bacteria;multi-drug resistance Pseudomonas and Acinetobacte;Methicillin-resistant coagulase negative Staphylococcus and aureus;multi-drug resistance Enterococcus faecium.This review presents updated treatment strategies from the published clinical literature and provides recommendations for clinical treatment of multi-drug resistant bacteria in children with hematonosis.

A previous study showed that quercetin inhibits astrogliosis in a scratch-wound model, but did not identify the underlying mechanisms. Here, we show that quercetin exerts no effect on apoptosis or the viability of astrocytes, but significantly inhibits their proliferation, arresting them in the G1 phase and decreasing the percentage of cells in the S and G2 phase. In addition, we found that quercetin significantly decreased the phosphorylation of ERK1/2 and FAK, a downstream ERK signaling protein. Inhibition of this pathway with U0126, an inhibitor of MAP kinase, retarded wound closure, whereas sustained p-ERK1/2 activation, induced by vanadate, restored astrocyte migration. Our findings thus indicate that quercetin inhibits healing in the scratch-wound model of primary astrocytes in two ways: blockade of the G1 to S phase cell cycle transition and inhibition of the ERK/FAK signaling pathway, which may contribute toward decreasing astroglial scar formation in vivo.

近一个世纪以来，抗菌药物在人类战胜各种感染性疾病的过程中发挥了关键作用，但日益突出的多重耐药菌问题已给临床抗感染治疗带来了严峻挑战。如何有效减缓多重耐药菌的产生，阻断多重耐药菌传播，已引起医学界、政府与社会的广泛关注。为加强多重耐药菌的医院感染管理，有效预防和控制多重耐药菌在医院内的产生和传播，保障患者的安全，由中国感染控制杂志组织，58位国内知名专家共同发起，邀请全国165位专家参与，历时10个月，召开了9场专题讨论会，在充分收集意见和讨论的基础上，最终形成了《多重耐药菌医院感染预防与控制中国专家共识》。共识荟萃了国内外多重耐药菌医院感染防控的最新进展，总结了我国大多数权威专家防控方面的宝贵经验，旨在规范和指导我国多重耐药菌医院感染的防控，提高我国多重耐药菌感染防控水平。

Quercetin has been confirmed to possess antihistamine, anti-inflammatory, antiviral, immunomodulatory, and antioxidant properties. Herein, we evaluated their antitumor activity in vitro by using KB/VCR oral cancer cells. We found that quercetin at 25 to 100 μmol/L effectively inhibited the migration and invasion of KB/VCR cells. Quercetin at dose ranging from 25 to 100 μmol/L significantly inhibited the growth of the KB/VCR cells and at 50 μmol/L arrested cells at the G1 phase and decreased the amount of cells in the S and G2 phase. Apoptosis analysis showed that quercetin at 50 or 100 μmol/L induced apoptosis of KB/VCR cells by suppressing expression of Bax and inducing the expression of Caspase-3 and Bcl-2. Furthermore, we also confirmed that quercetin from 25 to 100 μmol/L reversed gene-encoded Pglycoprotein (P-gp)-mediated MDR in KB/VCR cells by inhibiting the expression of P-gp. For combination treatment with vincristin (0.375 μmol/L) and quercetin (50 μmol/L), the proliferation rate significantly decreased and apoptosis rate significantly increased. This study provided evidence that quercetin induced apoptosis and reversed drug resistance in oral tumor cells and may be a potential candidate for other tumors treatment.

目的 有效规范临床用药,进行合理用药指标的监控,降低临床用药风险.方法 依据临床用药知识库,将用药规范和制度与医嘱系统流程融合;采用商业智能技术,抽取医院管理、医嘱、检验等临床业务数据库,建立主题模型,监测临床用药的各项指标.结果 软件化定制了临床用药规范和制度,在医嘱系统中实现提醒和审批流程.实时、精细化展示合理用药指标报表,并能进行潜入分析.结论 减少不合理用药医嘱,同时极大提高了合理用药数据统计、分析的效果和效率.

BACKGROUND To develop a real-time PCR assay for simultaneous detection and identification of clinically common bacteria and fungi causing meningitis from cerebrospinal fluid (CSF) samples. METHODS AND RESULTS A total of 11 Gram-positive bacteria, 9 Gram-negative bacteria, and 7 fungi were identified correctly with a universal primer and probe designed based on ribosomal RNA conserved sequences. The detection limit was defined as 10(2) copies of plasmid DNA as C(T) value < 35 for boundaries. Among 137 CSF samples from patients with suspicion of meningitis, 23 samples were positive with a rate of 16.8%, and significantly higher than that of conventional methods, such as microbial culture and India ink stain (chi2 = 5.82, p < 0.05). CONCLUSIONS TaqMan probe-based real-time PCR was proven to be a more rapid, sensitive, and specific method for the simultaneous detection of common bacteria and fungi. The method we established was not only applied to detect pathogens of CSF specimens, but also can also be applied to diagnose other biological fluids; it may be a supplementary assay and screening method to diagnose microorganisms.