Cross-sectional investigation of nosocomial infection in a tertiary general hospital and construction of a prediction model / 公共卫生与预防医学

Objective To understand the prevalence of nosocomial infection and its potential risk factors through a cross-sectional study, to construct a predictive model of the probability of nosocomial infection, and to provide a basis for nosocomial infection management. Methods The prevalence rate of nosocomial infection and potential risk factors of all inpatients in a tertiary general hospital were investigated on a certain day. The possible risk factors of nosocomial infection were analyzed, and a nomogram prediction model on the probability of nosocomial infection was established. The calibration curve and ROC curve were used to evaluate the predictive efficiency of the model. Results A total of 419 hospitalized patients were investigated, and the prevalence rate of nosocomial infection was 3.58%. The top three nosocomial infections were in ICU, neurosurgery, and cardiac surgery. The top three infection sites were surgical site infections, lower respiratory tract infections, and urinary tract infections. The results of univariate analysis showed that the length of hospital stay, surgery, antimicrobial use and underlying diseases were statistically related to the occurrence of nosocomial infections (all P<0.05). Logistic regression analysis showed that compared with the length of stay (LOS)＜14, the risk of nosocomial infection in patients with long LOS (≥14) was 5.48 (95% CI: 1.68-19.16). The risk of nosocomial infection in patients with two basic diseases was 7.61 times that (95%CI: 1.50-44.79) of patients without underlying diseases. The risk of nosocomial infection in patients with surgery was 4.88 times that of patients without surgery (95%CI: 1.47-19.6). According to the coefficients of the related risk factors calculated by logistic regression, a nomogram model of the occurrence probability of nosocomial infection was established. The C-index of the model was 0.839, and the area under the ROC curve for predictive efficiency was 0.809 (95%CI: 0.740-0.942). Conclusion Nosocomial infection control and management should be strengthened. Individual risk assessment of patients' nosocomial infection should consider about the age, underlying diseases, surgical status, glucocorticoid or immunosuppressive agents, and antimicrobial drug use. It is essential to identify the high-risk groups as soon as possible and take prevention and control measures to reduce the prevalence rate of nosocomial infection.

Research advances in the secondary resistance mechanism of imatinib in gastrointestinal stromal tumors / 中华胃肠外科杂志

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumors in the gastrointestinal tract. Though surgical resection is the only radical treatment, postoperative recurrence and metastasis often occur. The first-line therapy for the treatment of recurrent, metastatic and unresectable GIST is imatinib. More than 80% of patients can benefit from imatinib treatment, but half of patients will still have recurrence or metastasis within 2 years after treatment initiation, and secondary drug resistance is a major cause of disease progression. Therefore, adeep understanding of the mechanisms of secondary drug resistance will guide us to develop personalized therapeutic schedule in the future. This article describes the mechanism of IM secondary resistance from the aspects of gene alteration, abnormal activation of signal transduction pathway, autophagy, apoptosis and drug concentration. It is found that single drug therapy has certain limitations in patients with secondary resistance to IM. Using IM combined with downstream signaling molecule inhibitors, autophagy inhibitors, insulin-like growth factor 1 receptor (IGF-1R) inhibitors, heat shock protein 90 (HSP90) inhibitors, cytotoxic T lymphocyte - associated antigen - 4 (CTLA - 4) antibodies and mitochondrial inhibitors provide us new therapeutic ideas. However, these combination treatments are still in the research phase, and further trials are needed to confirm the safety and efficacy. With the gradual deepening of research on drug resistance mechanisms, it will provide more solutions to the current serious drug resistance problem.

Standardization of the endoscopic treatment for early gastric cancer / 中华胃肠外科杂志

With the increasing incidence of early gastric cancer, endoscopic treatment has been widely used. It has also played an important role in the diagnosis and treatment of gastric cancer. Therefore, it is very important to carry out standardized treatment with endoscopy. In theory, endoscopic resection can be performed in early gastric cancers which have no lymph node metastasis and also can be resected completely. Endoscopic therapy is absolutely indicated in macroscopically intramucosal differentiated carcinomas (pT1a) without ulcer or ulcer scar and with diameter ≤2 cm. The expanded indications are: (1) macroscopically intramucosal differentiated carcinomas (pT1a) without ulcer and with diameter >2 cm; (2) macroscopically intramucosal differentiated carcinomas (pT1a) with ulcer and with diameter ≤2 cm; (3) macroscopically intramucosal undifferentiated carcinomas (pT1a) without ulcer and with diameter ≤2 cm. Methods of preoperative evaluation include endoscopy, CT, and endoscopic ultrasonography (EUS). For tumor size greater than 3 cm and undifferentiated lesions, evaluation should be carried out carefully in order to avoid the underestimation of T staging. During endoscopic surgery, the extent, nature, and depth of the lesion should be clearly defined again, if necessary, assisted by staining endoscopy. In order to avoid complications such as bleeding and perforation, stanch bleeding and aspiration of gas should be performed promptly during the operation. After endoscopic resection, when pathology reveals positive margin of resected specimen, lesions invading deep submucosa, vascular involvement or peri-gastric lymph node metastasis, additional surgery should be recommended. Even if the patients have been evaluated as radical treatment, close follow-up is still necessary. Only when surgeons strictly obey the indications of endoscopic treatment, make the accurate evaluations for the patients before operation, undergo endoscopic operation carefully, and perform the follow up closely, the patients can be benefit from endoscopic therapy really.

Literature review of global economic burden of diseases due to needlestick inj uries among health care workers / 中国感染控制杂志

Objective To understand the global economic burden of diseases due to needle stick injuries(NSIs), obtain relevant evidence,and prompt the relevant departments to pay attention to the precaution of NSIs.Methods Literatures about NSIs published from 1990 to May 2016 were searched from PubMed,ScienceDirect,EBSCO-host,Cochrane,CNKI,and Wanfang database.According to world bank inflation rate and currency rate in 2015, cost of needle stick injury in each study was adjusted to US dollars in December 2015,merge comparison analysis was performed.Results A total of 7 literatures were included,3 American studies and 4 studies from Sweden,Ko-rea,Belgium,and Taiwan Region of China respectively.Studies in mainland China only focused on the incidence of NSIs,studies about cost were not found.Two studies did not identify studied population,the remaining 5 studies were about all staff in the medical institutions.Cost analysis method:Of 7 literatures,3 were first-hand data analy-sis,4 were derived from the model.Scope of cost research:4 studies estimated the direct cost,2 calculated direct and indirect cost respectively,only 1 study estimated the summation of direct and indirect cost.The total cost per inj ury (direct cost + indirect cost)was $747-$2173,direct and indirect cost were $167-$617 and $322-$455 respectively.Conclusion Global economic burden of NSIs is heavy and still undervalued;NSIs occur frequently in China,but attention is inadequate,research on economic burden is lacking,relevant departments should pay atten-tion to the prevention and follow-up treatment process of NSIs.

Efficacy analysis of targeted therapy combined with surgery in the treatment of recurrent and metastatic gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of targeted therapy combined with surgery in the treatment of recurrent and metastatic gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>Clinicopathological and followed-up data of 318 patients with recurrent and metastatic GIST admitted in Zhongshan Hospital between January 2000 and December 2015 were analyzed retrospectively. According to different treatment methods, the patients were divided into four groups: surgery group (operation alone, 44 cases), target therapy group (imatinib alone, 108 cases), target therapy combined with surgery group (imatinib plus operation, 139 cases), other therapy group (chemotherapy, Chinese medicine and others, 27 cases). The progression-free survival (PFS) and overall survival (OS) of four groups were compared.</p><p><b>RESULTS</b>The baseline informations, such as age, gender, primary site, et al, were not significantly different (all P>0.05), but the recurrent and metastatic site was significantly different among 4 groups (P=0.000). The medial PFS of surgery group, target therapy group, target therapy combined with surgery was 16(95%CI: 4.9 to 27.0) months, 44 (95%CI: 30.9 to 57.1) months, 35 (95%CI: 26.5 to 43.5) months, respectively, and the latter 2 groups had significantly longer PFS than surgery group(P=0.000), while no significant difference was found between target therapy group and target combined with surgery group (P=0.251). The median OS of surgery group, target therapy group, target therapy combined with surgery, and other therapy group was 24 (95%CI: 9.0 to 39.0) months, 69(95%CI: 40.8 to 97.2) months, 92(95%CI: 78.0 to 106.0) months, 12(95%CI: 9.5 to 14.5) months. Target therapy group and target therapy combined with surgery group had significantly longer OS than surgery and other therapy groups (P=0.000), while the target therapy combined with surgery group had significantly longer OS than target therapy group(P=0.028).</p><p><b>CONCLUSION</b>Target therapy combined with surgery can prolong the survival of recurrent and metastatic GIST patients.</p>

Prevention and management of pseudoaneurysm after radical gastrectomy for gastric cancer / 中华胃肠外科杂志

With the promotion of standard radical resection of gastric cancer, the incidence of postoperative pseudoaneurysm is significantly increasing. Both the patient's own factors and iatrogenic factors are accoutable. Surgeons should clarify the causes of pseudoaneurysm, pay attention to the clinical symptoms and signs, and treat the patients appropriately. In order to avoid the occurrence of postoperative pseudoaneurysm, surgeons should carefully evaluate the preoperative conditions, perform precision operation and reduce the morbidity of postoperative infection and fistula.

Clinicopathological features of small gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features of small gastrointestinal stromal tumors(GISTs) and to evaluate the efficacy of endoscopic therapy for GISTs.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 418 patients with GISTs undergoing endoscopic therapy in the Zhongshan Hospital between January 2009 and July 2014 were analyzed retrospectively. All the cases were evaluated by the NIH risk classification and AIFP classification, and were grouped according to the tumor size and location. Nuclear atypia and mitotic count were used to evaluate the biological behavior of small GIST. Efficacy of endoscopic therapy was analyzed with follow-up data.</p><p><b>RESULTS</b>Out of 418 patients, GISTs located in the esophagus was 14(3.3%), in the stomach 389(93.1%), in the duodenum 5(1.2%), in the rectum 10(2.4%). A total of 412(98.6%) patients were mainly spindle cells, and mitosis was not found in 320(76.5%) patients. In 389 small stomach GIST, 245(58.6%) were in fundic region. Cases were divided into four groups according to the size and the result revealed the bigger the size, the more the mitotic count. Nuclear atypia in the 1.5-1.9 cm group was significantly higher compared to other groups. Cases were divided into four groups according to the location and the result revealed the mitotic count was not associated to the location. While the nuclear atypia of stomach GIST was significantly higher than that of esophageal GIST and the nuclear atypia of rectum GIST was significantly higher than that of other positions. The median follow-up was 32(4-69) months. One case(gastric fundus GIST, >1.5 cm) presented local recurrence 23 months after operation and underwent endoscopic resection again. No recurrence or metastasis was found in other patients.</p><p><b>CONCLUSIONS</b>Endoscopic resection technique is effective for small GISTs patients. The small GISTs with 0.4 cm diameter or less are often benign and should be followed up for long time. The small GISTs with 0.5 cm diameter or more possess the risk of malignancy, then surgical resection should be performed. Rectum small GISTs (except for 0.4 cm diameter or less) have worse biological behavior and should be removed.</p>

Clinicopathological analysis of 80 patients with duodenum gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics, efficacy, and prognostic factors for patients with duodenum gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>Clinicopathological and follow-up data of 80 patients with duodenum GIST in the Zhongshan Hospital from January 2000 to December 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 38 male and 42 female patients with a median age of 54 years. The major symptoms were upper alimentary tract hemorrhage and abdominal pain. Thirty-nine patients received local tumor excision, 18 patients underwent segmental duodenectomy, 23 patients were subjected to pancreaticoduodenectomy, all these operations were R0 resection. Thirty patients received imatinib treatment after operation, and 11 among them had metastasis relapse. Recurrence-free survival rates of 1-, 3-, and 5-years were 96.2%, 90.6%and 78.6% retrospectively. Overall survival rates of 1-, 3-, and 5-years were 100%, 98.3% and 96.1%. Multivariate Cox analysis showed tumor size >5 cm, mitotic count >5 mitosis/50 HPF and intermediate/high NIH risk classification were associated with an increased risk of recurrence. The significant difference was not detected between the limited resection group and pancreaticoduodenectomy group in OS and RFS.</p><p><b>CONCLUSIONS</b>Surgery is still the main treatment for duodenum GIST. The surgical program is mainly determined by the location and size of tumor. Imatinib therapy should be used if necessary.</p>

Evaluation and endoscopic treatment of small and micro gastrointestinal stromal tumors / 中华胃肠外科杂志

The incidence of small and micro gastrointestinal stromal tumors is increasing significantly because of the enhanced health consciousness and advanced endoscopic technology. But there still is controversial in the biological behavior and clinical treatment of GIST. The treatment of the GIST with endoscopic technology has obvious advantages. This method can remove tumor and avoid significant trauma. In this paper, the biological behavior, clinical evaluation and endoscopic treatment of the GIST are discussed.

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and short-term efficacy of laparoscopic resection of primary localized gastric gastrointestinal stromal tumors (GIST) by comparing with open surgery.</p><p><b>METHODS</b>Clinicopathological data of 167 gastric GIST patients undergoing operation in Zhongshan Hospital from June 2008 to December 2013 were retrospectively analyzed, among whom 55 received laparoscopic surgery and 112 underwent open surgery for primary local gastric GIST. Efficacy of different size and different location of GIST was compared between laparoscopic and open groups.</p><p><b>RESULTS</b>There was no conversion to open surgery in laparoscopy group. Compared with open surgery, laparoscopic resection for gastric GIST smaller than 5 cm or located at anterior wall, greater curvature, lesser curvature, was associated with similar operation time(P>0.05), but less blood loss, shorter post-hospital stay or flatus time(all P<0.05). The operative outcomes were similar between laparoscopic and open resection for gastric GIST bigger than or equal to 5 cm or located at posterior wall(all P>0.05), except the longer operation time in laparoscopy group(P<0.05). The incidence of postoperative complication did not differ between two groups. Laparoscopic group had 2 patients with gastroparesis and open group had 2 gastroparesis, 2 pulmonary infection, and 1 poor wound healing(all P>0.05), which all recovered after conservative treatment. During 7 to 84 months(median 35) of follow-up, no recurrence or hepatic metastasis was found in laparoscopy group, and 3 hepatic metastases in open group. There was no significant difference of recurrence-free survival between two groups(P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic resection for gastric GIST is safe and effective in selected patients, especially for those with tumors smaller than 5 cm, or located at anterior wall, greater curvature, lesser curvature, whose short-term outcomes are better than open resection.</p>

A multicenter prospective monitoring on incidences of ventilator-associated pneumonia in 46 hospitals in China / 中国感染控制杂志

Objective To explore the incidences of ventilator-associated pneumonia (VAP)in intensive care units (ICUs)in China.Methods From October 2013 to September 2014,46 hospitals in 12 provinces and cities were se-lected to participate in the study,all patients admitted to ICUs were included,the incidences of VAP were surveyed and compared with data from the U.S.National Healthcare Safety Network (NHSN).Results A total of 17 358 patients were surveyed,the total patient-days were 176 096 d,the total catheter-days were 91 448 d,813 patients developed VAP,the incidence of VAP was 8.89/1 000 catheter-days,VAP mainly occurred in general ICUs (76.74%);the incidences of VAP were varied with patients in different types of ICUs,ranging from 4.50/1 000 catheter-days to 32.79/ 1 000 catheter-days.Conclusion The incidence of VAP in patients in ICUs at 46 hospitals in China is significantly higher than that reported by NHSN,even higher than the P90 .

Clinical features and prognostic analysis of 75 primary myelofibrosis patients / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the clinical and hematological features and prognostic factors of primary myelofibrosis (PMF) patients in Shanghai and surrounding area of Shanghai, China.</p><p><b>METHODS</b>The clinical manifestations, laboratory parameters and survival were retrospectively analyzed in 75 PMF patients diagnosed from Jan, 1996 to Dec, 2013 in our hospital and were compared with those of Chinese subjects from Tianjin and foreign Caucasian patients, respectively. Comparison of categorical variables was performed by χ² test. Survival was estimated using the Kaplan- Meier method. Log- rank test was used to compare survival date. A Cox model was used for multivariate analyses.</p><p><b>RESULTS</b>The median age of the 75 patients was 56(19-81) years old. There were 51(68%) patients with HGB less than 100 g/L. The median value of HGB was 83 g/L. Similar with those from Tianjin, the patients in our study were significantly younger with higher proportion of severe anemia and lower platelet counts when compared with foreign Caucasian patients. Using IPSS and dynamic international prognostic scoring system (DIPSS) model, the survival curves of intermediate- 1, intermediate- 2 and high risk groups were significantly different. In univariate analyses, variables significantly correlated with poor prognosis were systemic symptoms, HGB<100 g/L, HGB<80 g/L, PLT ≤ 100 × 10⁹/L, WBC<10 × 10⁹/L and blood blasts ≥ 0.01. Multivariate analysis identified IPSS and HGB < 80 g/L as independent risk factors for survival.</p><p><b>CONCLUSION</b>Chinese PMF patients may have characteristics of younger age at onset with more severe anemia. However, IPSS and DIPSS model are still suitable for Chinese patients to predict survival. To increase the weight of anemia severity may provide a better prognostic stratification for Chinese patients with PMF.</p>

An analysis of clinical characteristics, etiologies and prognosis of 218 patients with infective endocarditis / 中华内科杂志

Objective To describe the profile of patients with infective endocarditis (IE) and assess prognostic factors of IE.Methods Clinical and etiology data of 218 patients with IE were collected retrospectively from January 2011 to January 2013.The distribution and antimicrobial susceptibilities of pathogens causing IE were evaluated.Prognostic factors associated with IE were determined by univariate and multivariate regression analysis.Results There were 148 men and 70 women with age of (46.0 ± 14.6)years.Ninety-five (43.6％) of them had heart diseases,including 72 cases (33.0％) of congenital heart disease and 23 cases (10.6％) of chronic rheumatic heart disease.Vegetations were detected by echocardiography in 171 (78.4％) patients.Microorganisms causing IE were identified in 84 cases (38.5％) cases.Streptococcus viridans was the dominant pathogen,accoumed for 63.1％ of all the pathogens,followed by Staphylococcus (13.1％) and Enterococcus (4.8％).Totally 7/11 Streptococcus viridans was susceptible to penicillin,while 100％ susceptible to the third and fourth generation cephalosporins,vancomycin and linezolid.One hundred and eighty cases underwent operations.The in-hospital mortality rate of IE was 3.2％.In univariate regression,health care-associated infection,prosthetic valve,anemia and chest symptoms (distress or pain) were related to the increased risk of mortality in patients with IE,while surgery appeared to be a protective factor.In the logistic regression model,the variables significantly associated with IE prognosis were health care-associated infection (OR =17.03,95％ CI 1.76-164.75,P =0.014) and anemia (Hb ＜ 90 g/L) (OR =13.47,95％ CI 2.46-73.60,P =0.003) and surgery treatment (OR =0.17,95％ CI 0.03-0.97,P =0.047).Conclusions Although Streptococcus viridans is the most common pathogen causing IE,the pathogens of IE become versatile.The antibacterial activity of penicillin against Streptococcus viridans is low.Health care-associated infection and anemia are risk factors of IE prognosis,while surgery treatment is a protective factor of severe IE.

Perioperative antibiotic prophylaxis in colorectal surgery: an investigation of 2 465 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of changes in perioperative antibiotic prophylaxis (PAP) duration in colorectal surgery on surgical site infection (SSI).</p><p><b>METHODS</b>The data on PAP in April and October between 2011 and 2013 was collected from tertiary and secondary hospitals in Shanghai. Prevalence of SSI rates over the same period was compared.</p><p><b>RESULTS</b>A total of 2 465 cases of colorectal surgeries were studied over the three-year period, including 1 784 cases in tertiary hospitals and 681 cases in secondary hospitals. In 940 surgical operations, PAP duration were within 72 hours, accounting for 38.1% of all cases. 48.0% of the operations in 2013 had a PAP within 72 hours, which is significantly higher than that of 20.8% seen in 2011 (χ(2) = 129.986, P = 0.000). In 2013, 53.5% of the all procedures in tertiary hospitals had PAP ≤ 72 hours, compared with 35.5% in secondary hospitals over the same period (χ(2) = 22.714, P = 0.000). Combined uses of nitroimidazoles, with an effect of anti-anaerobic, were used much more commonly in tertiary (76.0%) than in secondary hospitals (41.4%) (χ(2) = 267.820, P = 0.000). The usage of cephamycin were higher in secondary (20.6%) than in tertiary hospitals (4.7%) (χ(2) = 149.865, P = 0.000). According to the investigations by SICC on prevalence of healthcare-associated infections between 2011 and 2013, colorectal surgeries have an average SSI rate of 2.0%. Stratified data showed that the rate of PAP ≤ 72 hours increase from 23.6% in 2011 to 45.8% in 2013 over the same period. However, the SSI rate did not show a significant change (1.9% in 2011, 1.7% in 2013). There was no linearly dependent between the two rates (r = 0.015, P = 0.990).</p><p><b>CONCLUSIONS</b>The proportion of rational PAP of colorectal surgeries in Shanghai has increased. Perioperative antibiotic prophylaxis duration decreased, while SSI rates over the same period did not increase.</p>

Toll-like receptor 4 on islet beta cells senses expression changes in high-mobility group box 1 and contributes to the initiation of type 1 diabetes

Type 1 diabetes mellitus is caused by the autoimmune destruction of beta cells within the islets. In recent years, innate immunity has been proposed to play a key role in this process. High-mobility group box 1 (HMGB1), an inflammatory trigger in a number of autoimmune diseases, activates proinflammatory responses following its release from necrotic cells. Our aim was to determine the significance of HMGB1 in the natural history of diabetes in non-obese diabetic (NOD) mice. We observed that the rate of HMGB1 expression in the cytoplasm of islets was much greater in diabetic mice compared with non-diabetic mice. The majority of cells positively stained for toll-like receptor 4 (TLR4) were beta cells; few alpha cells were stained for TLR4. Thus, we examined the effects of anti-TLR4 antibodies on HMGB1 cell surface binding, which confirmed that HMGB1 interacts with TLR4 in isolated islets. Expression changes in HMGB1 and TLR4 were detected throughout the course of diabetes. Our findings indicate that TLR4 is the main receptor on beta cells and that HMGB1 may signal via TLR4 to selectively damage beta cells rather than alpha cells during the development of type 1 diabetes mellitus.

Genotyping of carbapenem-resistant Acinetobacter baumannii acquired from environment and patients in intensive care units by REP-PCR / 中华微生物学和免疫学杂志

Objective To investigate the genotype of carbapenem-resistant Acinetobacter baumannii(CRAB) acquired from intensive care units (ICUs) environment in Shanghai hospitals and to evaluate the gene homology of CRAB isolated from patients and environment in ICUs in Shanghai hospital.Methods Sixty-one CRAB isolated from ICUs environment in Shanghai hospitals and 14 strains isolated from ICUs patients in S hospital were typed by REP-PCR based DiversiLab system.Results There were 7 types of the CRAB isolated from ICUs environment in Shanghai hospitals.Type G1 was the dominant type,accounting for 75.4％ of all CRAB,mainly in 13 hospitals in Shanghai.The percentage of the 7 types CRAB strains were 75.4％,13.1％,3.3％,1.6％,1.6％,3.3％ and 1.6％,respectively.Except for 1 strain of type G6 isolated in D hospital,type G1 CRAB was identified in every hospital which was isolated CRAB.There were 25 strains isolated from patients and environment in S hospital ICUs,which were divided into 4 types.Type G1 was the dominant type mainly distributed in SICU and CICU,including 9 from patients and 8 from environment.The distribution diagram of environmental and patients' strains indicated that the patients in adjacent bed isolated G1 CRAB in SICU and a patient in CICU and its surrounding environment both isolated G1 CRAB.Conclusion Type G1 is the dominant type in ICUs environment in Shanghai hospitals.There are inter-hospital transmission of CRAB in ICUs environment and highly homology of CRAB isolated from patients and environment in ICUs in Shanghai hospitals.Active surveillance of infection and colonization by CRAB,together with implementation of enhanced control strategies should be taken to eradicate CRAB in ICU environment.

The characteristics of CT imaging and diagnosis of pulmonary cryptococcosis in 42 cases with non-acquired immune deficiency syndrome / 中华内科杂志

Objective To further elucidate the CT characteristics and diagnostic approaches to non-acquired immune deficiency syndrome patients with pulmonary cryptococcosis. Methods The histories of forty-two pulmonary cryptococcosis (PC) patients diagnosed in Zhongshan Hospital from 2003 -2008 were collected and analyzed for demography data, underlying conditions, clinical symptoms, chest CT and diagnostic studies. Results None of the 42 PC patients had avian or its feces contacting history, and 71.4% (30/42) of them were immunocompetent. The most frequent CT lesions were multiple nodules (67. 9% ) with peripheral predominance (67. 9% ), and cavitations (50%) often presented within them. Masses/consolidation (31.4%) and patching lesions (2. 9% ) could exist occassionally. Positive detection rates of non-aggressive examinations including sputum, bronchoalveolar lavage fluid and bronchofibroscope aspiration were 4. 3%, 8. 3% and 6. 3% respectively, while those of aggressive approaches including transbrunchial lung biopsy (TBLB), thin needle aspiration biopsy (TNAB) and pneumonectomy by surgery were 64. 7%, 64. 3% and 100% respectively. Non-aggressive serum cryptococcus antigen test was performed in 14 patients who had been diagnosed by histopathology or pathogen culture, and all of them were positive. Conclusion Our study suggests that PC is common in immunocompetent population. Avian or its feces contacting is not so important as used opinion to PC differential diagnosis. CT characteristics of PC are diversiform and always change very slowly. Besides the most frequent multiple nodules with subpleural predominance, pulmonary lesions can present as masses, consolidation or patchings. Aggressive techniques such as TBLB and TNAB are benefit to clinical diagnosis of PC, and non-aggressive serum cryptococcus antigen test may be promising for its early diagnosis as well as clinical course follow-up and therapeutic effect evaluation.

Prognostic factors related to community acquired pneumonia / 中华临床感染病杂志

Objective To investigate the prognosis and related factors of community acquired pneumonia (CAP). Methods From August 2003 to March 2009, 689 CAP cases from 37 hospitals of 23 cities in China were enrolled. The onset information and clinical outcomes in one month of onset were recorded. Pearson Chi-square test and Logistic regression test were performed using the SPSS 12.0 software to identify prognosis-related factors. Results Among 689 patients there were 396 male and 293 female. The median age was (53 19) years old, 247 patients (35.8%) were≥65 years old. Forty four patients died with a fatality rate of 6.4%. Univariate analysis identified 19 risk factors, they were age≥65 years old, smoking, aspiration, use of antimicrobial agents in 3 months, use of immunodepressant in 2 months, heart failure, chronic renal failure, chronic liver disease, eerebrovascular disease, diabetes, emaciation, altered mental status, respiratory rate > 28/min, pulse > 100/min, lower diastolic blood pressure, neutrophil ratio > 0.9, ALT >40 U/L, elevated blood urea nitrogen level and PORT classification ≥Ⅳ. By multivariate analysis, use of antimicrobial agents in 3 months, respiratory rate > 28/min, pulse > 100/min and PORT classifications≥Ⅳ were identified as the independent risk factors for mortality. Conclusions The general fatality rate of CAP is low in China. Use of antimicrobial agents in 3 months, respiratory rate > 28/min, pulse > 100/min and PORT classifications≥Ⅳ are independent risk factors for mortality.

A multicenter prospective cohort study on risk factors for hospital-acquired pneumonia in the elderly / 中华内科杂志

Objective To investigate the incidence and the risk factors for hospital-acquired pneumonia(HAP)in the elderly in Shanghai.Methods This was a muhicenter prospective clinical cohort study.A total of 5299 patients more than 65 years old.admitted into 31 secondary or tertiary hospitals in Shanghai,were enrolled.Measurements of the demographic and potential risk factors reflecting illness severity,nutrition,drug exposure,surgery and ventilation were performed.Pneumonia was classified by the definition of Chinese Medical Association.Risk factors were analyzed by univariate Pearson Chi-squared test and multivariable logistic regression analysis with backward(Likelihood ratio).Resuits Of the enrolled patients,2805 male and 2494 female,255(4.81%)developed hospital-acquired pneumonia.The incidence was 46.75/1000 hospitalizations.Among them 38 died:and the rough mortality was 14.90%.The incidence of HAP was higher in ICU(21.43%),hematology(12.17%),chest surgery(11.41%),and respiratory medicine(7.92%)departments.The mean of acute physiology and chronic health evaluation (APACHE Ⅱ)score was 8.3±3.4(5-31).Multivariable logistic regression analysis with backward (Wald)method found that admission into secondary hospitals.admission into ICU,history of chronic obstructive pulmonary disease≥10 years,immunosuppression,administration of antibiotics,insertion of nasogastric tube,mechanical ventilation,administration of H-2 antagonists or antacid and≤7 d,central nervous system diseases,depressed level of consciousness,supine position,albumin＜35g/L were independent risk factors of HAP in the elderly.Conclusion Hospital-acquired pneumonia in the elderly was the usual type of nosocomial infections.The risk factors identified from this study may prove useful to target future clinical interventions to prevent HAP in the elderly.

Effect Evaluation of 3M~(TM) Surface Disinfectant on ICU Environment / 中华医院感染学杂志

OBJECTIVE To compare the disinfection effect of 3MTM object surface disinfectant(3M disinfectant) with that of chlorine-containing disinfectants in ICU environment. METHODS The floor, instrument panel board, ward bed tables,computer key boards and telephone keyings were sampled respectively before disinfection, 15 minutes and 4 hours after disinfetion in six ICUs. The bactericide rate of 3M disinfectant and chlorine-containing was compared. RESULTS In the 96 specimens collected, 26 from ward bed tables(48.15%)and 22 from instrument panel board, computer key boards and telephone keyings (26.83%)excede the standard of Ministry of Health(