ABSTRACT
Objective To investigate the morbidity and risk factors of peripherally inserted central catheter (PICC) related bloodstream infection and the distribution and antimicrobial susceptibility of pathogens in patients with hematological malignancy for better prevention and management of such infections. Methods The relevant data were collected from the patients with hematologic malignancy and PICC in hematology department from July 2013 to November 2016. The risk factors of PICC related bloodstream infection were analyzed. Blood samples and catheter-related blood samples were taken for culture of pathogens. The pathogens were identified on VITEK-32. Antimicrobial susceptibility was tested by using Kirby-Bauer method. Results A total of 10 213 patients with PICC were included in this study. PICC related bloodstream infection was identified in 280 (2.74％) patients, about 0.55 per 1 000 PICC days. The main risk factors of PICC related bloodstream infection were type of hematological malignancy (P＜0.001) and days of indwelling PICC (P＜0.001). A total of 322 strains of pathogenic bacteria were isolated, including gam-negative bacteria (73.91％), gam positive bacteria (22.05％) and fungus (4.04％). The gram-negative species isolated from bloodstream were mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. E. coli and K. pneumoniae isolates were relatively sensitive to piperacillin-tazobactam, cefepime, cefoperazone-sulbactam, imipenem, gentamicin and amikacin. S. maltophilia isolates were relatively sensitive to piperacillin-tazobactam, ceftazidime, cefoperazone sulbactam and ciprofloxacin, while P. aeruginosa strains were relatively sensitive to the commonly used anti-Pseudomonas antibiotics. The gram-positive isolates including Staphylococcus epidermidis, Staphylococcus hominis and Staphylococcus haemolyticus were all susceptible to vancomycin, linezolid, and teicoplanin. The most frequently identified fungal species was Candida tropicalis. Conclusions Prolonged duration of PICC may increase the risk of central line-associated bloodstream infection (CLABSI). The incidence of CLABSI is associated with the type of hematological malignancy. CLABSI pathogens are mainly gram-negative microorganisms with various levels of antibiotic resistance. Clinicians should adhere to standard operating procedures, strengthen surveillance of patients with PICC, evaluate the risk dynamically, and remove PICC as early as possible.
ABSTRACT
Objective To understand the cleaning quality of dental handpieces in Suzhou City, analyze the relevant factors that influencing cleaning effect.Methods A cross-sectional study was performed with the proportional system sampling method, questionnaires were adopted to investigate the cleaning location, cleaning method and process of dental handpieces, the ATP fluorescence detection method was conducted to detect cleaning quality.Results In 10 administrative regions of this city, a total of 72 medical institutions were selected, 25 were public medical oral diagnosis and treatment institutions, 47 were private clinics.Cleaning effect of automatic handpiece cleaning machine was better than traditional manual cleaning (unqualified rate :3.95% vs 11.96%, P0.05).The quality of cleaning of handpieces could be improved if waiting time of cleaning ≤30 minutes, enzymes were used during cleaning, and purified water was used at the end rinse(all P<0.05);whether there was drying process and used lubricant, difference were both not significant.Conclusion Using automatic handpiece cleaning machine, cleaning personnel with adequate knowledge, cleaning waiting time ≤30 minutes, enzyme use during the cleaning process, and purified water use at the end rinse can improve the quality of cleaning of dental handpieces.
ABSTRACT
Objective To explore the cleaning status and cleaning quality of dental handpieces in various types of medical institutions in Suzhou City.Methods On October 26-31, 2015, dental clinics in the whole city were sampled according to cross-sectional survey and proportional sampling method, the cleaning quality of dental handpieces in each clinic was detected by ATP bioluminescence assay.Results 72 medical institutions, 201 handpieces, 402 samples in 10 administrative regions of the city were sampled, 42 samples was unqualified, unqualified rate was 10.45％, unqualified rate of cleaning of dental handpiece surface was higher than waterline of dental handpiece(17.91％ vs 2.99％, P<0.05).Cleaning quality of dental handpieces in different grades of medical institutions was different(P<0.05), tertiary medical institutions were all ualified, medical institutions without grade was 14.45％.According to the classification based on name of different medical institutions, cleaning quality of handpieces was statistically significant(P<0.05), cleaning efficacy of dental handpieces in department of stomatology of public hospitals was best(unqualified rate was 4.31％), while private dental clinics had the worst cleaning efficacy(unqualified rate was 13.81％).Conclusion Education and training of dental handpieces cleaning in the whole city should be strengthened, especially the management of cleaning of dental handpieces in low grade and private dental clinics.
ABSTRACT
Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.
ABSTRACT
Objective To provide reference for establishing diagnosis and differential diagnosis methods of rare yeast-like fungal bloodstream infection for clinical microbiology laboratory.Methods Trichosporon asahii (T.asa-hii)and Geotrichum capitatum (G.capitatum)bloodstream infection was diagnosed and differentially diagnosed through clinical data analysis,morphological examination,biochemical reactions,and molecular biology technology. Results Two types of yeast-like fungal bloodstream infections in case 1 and case 2 both occurred in leukemia agranulocytosis phase after chemotherapy,such infections were serious and highly similar.The cultivated colonies on blood agar plates of case 1 and case 2 were performed gram stain and microscopic examination.Hyphae,arthro-spores and microconidia were visible in the former,thickness of hyphae branches and length of arthrospores were different,most presented rectangular and barrel shape;the latter can be seen hyphae with transparent septum bro-ken up into arthrospores,presented rectangular shape,did not produce blastoconidia.Identification with API 20C AUX showed that they were T.asahii and G.capitatum.The PCR product sequences were compared with NCBI, suggesting that T.asahii and G.capitatum were at sexual stage.Conclusion Comprehensive application of a varie-ty of technical methods is helpful for improving the diagnosis accuracy of bloodstream infection with yeast-like fungi, identifying Trichosporon and Geotrichum to the species level may help physicians to understand such rare fungal in-fection,choose antifungal agents rationally,and improve clinical prognosis.