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Objective To understand the current status of healthcare-associated infections (HAI) among inpatients in medical institutions of Wuhan, and to provide a scientific basis for improving the management of healthcare-associated infections. Methods A combined method of bedside investigation and case review of the patients’ medical records were used to investigate all hospitalized patients in 31 hospitals. Results A total of 42 429 inpatients were investigated, of whom 938 had HAI (2.21%), and 7 561 had community-associated infection (CAI, 17.82%). The top three departments with the highest prevalence rate of HAI were ICU (17.95%), hematology (8.49%), and neurosurgery (6.57%), while the top three departments with the highest prevalence rate of CAI were burns (75.00%), pediatric non-neonatal group (70.26%) and respiratory department (67.53%). Both healthcare-associated infections and community infections were mainly in the lower respiratory tract, which accounted for 47.33% and 53.00%, respectively. The main pathogens of both HAI and CAI were Gram-negative bacteria, which accounted for 65.03% and 57.73%, respectively. The use rate of antimicrobial drugs was 31.74%, and the detection rate of pathogenic bacteria before antimicrobial treatment was 55.77%. The three departments with the highest rates of the use of antibacterial drugs were the pediatric non-neonatal group (78.20%), the department of burns (75.00%) and the department of urology (73.24%). Conclusion ICU, hematology department, and neurosurgery department were high-risk departments for healthcare-associated infections. Pediatrics, burns, and urology departments were the departments with high use of antibacterial drugs. The pathogenic bacterial detection rate has declined, which needs to be strengthened.
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Objective To understand the microbiological and clinical features of bloodstream infection(BSI) with high virulent Klebsiella pneumoniae(hvKP).Methods The strains and clinical data of 159 patients with Klebsiella pneumoniae (K.pneumoniae) BSI at the Second Hospital of Dalian Medical University from April 2013 to March 2016 were collected.Statistical analysis was performed using SPSS 19.0 software.Results 35.22％(56/159)of patients were with hvKP BSI,K1 and K2 serotypes in hvKP BSI accounted for 51.79％ and 26.79％ respectively.The main source of hvKP BSI was liver abscess(n =26,46.43 ％),the classic type of K.pneumoniae (cKP) BSI was primary bacteremia(n =41,39.81 ％).Difference in different types of infection between two groups of patients was statistically significant(x2 =57.782,P＜0.001),89.29 ％ of hvKP BSI was community-associated infection(CAI),and 73.79％ of cKP BSI was healthcare-associated infection(HAI).Difference in underlying diseases between two groups of patients was statistically significant(x2 =36.532,P＜0.001),50.00％ of hvKP BSI patients had diabetes,45.63％ of cKP BSI patients had malignant tumor.Icidence of septic shock in hvKP BSI patients was higher than that of cKP BSI patients(32.14％ vs 8.74％;x2 =14.096,P＜0.001).The proportion of ESBLs-producing of hvKP and cKP were 5.36％ (3/56)and 47.57％ (49/103)respectively,difference was statistically significant(x2 =29.375,P＜0.001).Klebsiella pneumoniae carbapemase(KPC)-producing hvKP was not found.Resistance rates of hvKP to ceftazidime,ceftriaxone,cefepime,aztreonam,gentamicin,levofloxacin,and compound sulfamethoxazole were all lower than cKP(all P＜0.05).Conclusion hvKP BSI is common in CAI,infection sources and underlying diseases are difference from cKP BSI,hvKP BSI is prone to cause septic shock.Both laboratories and clinicians should pay attention to hvKP infection and the change trend of antimicrobial resistance.
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Objective To investigate the prevalence rates of healthcare-associated infection(HAI) and community-associated infection(CAI) in hospitalized patients in Wuhan City, and provide a scientific basis for the prevention and control of HAI.Methods Convenience sampling method was used to select 33 hospitals in Wuhan City, all hospitalized patients were surveyed by bedside investigation and medical record reviewing, SPSS 16.0 software was used for data analysis.Results A total of 36 222 hospitalized patients were investigated, of whom 1 116 (3.08%) had HAI, 6 968 (19.24%) had CAI.The prevalence rate of HAI was highest in hospitals with ≥900 beds(3.40%), and the prevalence rate of CAI was highest in hospitals with<300 beds (43.70%).Of departments, general intensive care unit had the highest prevalence rate of HAI(32.88%), department of respiratory diseases had the highest prevalence rate of CAI (78.34%).A total of 699 pathogens were isolated from patients with HAI, the top three were Pseudomonas aeruginosa (18.03%), Acinetobacter baumannii (16.31%) and Staphylococcus aureus (12.88%), a total of 1 149 pathogens were isolated from patients with CAI, the top three were Escherichia coli (14.45%), Pseudomonas aeruginosa (11.23%), and Mycoplasma (10.01%).The main infected sites of both HAI and CAI were the lower respiratory tract, accounting for 48.24% and 45.15% respectively.Conclusion HAI and CAI have different characteristics, it is necessary to take targeted measures according to key departments and key sites, so as to reduce the occurrence of HAI effectively.
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Objective To investigate prevalence of healthcare-associated infection(HAI) and community associated infection(CAD in hospitalized patients in Hebei Province.Methods A certain day from August 17 to August 28,2015 was selected as the survey day,unified questionnaires were formulated,the prevalence of HAI and CAI in hospitalized patients in secondary and above comprehensive hospitals in Hebei Province was surveyed,pathogens causing infection were analyzed and compared.Results A total of 65 065 patients in 253 hospitals were surveyed,prevalence rates of HAI and CAI were 2.89％ and 16.84％ respectively.The top three sites of HAI were respiratory tract(61.32％),urinary tract(12.49％),and surgical site(9.83％),the top three sites of CAI were respiratory tract (56.70％),urinary tract(10.89％),and gastrointestinal tract(8.35％).Distribution of sites of HAI and CAI was significantly different(P＜0.01).The top 5 pathogens were of the same species,but ranked differently,the main bacteria causing HAI was Pseudomonas aeruginosa (22.69％),CAI was Escherichia coli (23.79％).There was significant difference in the distribution of pathogens between HAI and CAI (P＜0.01).There were significant differences in pathogenic species causing respiratory tract,gastrointestinal tract,urinary tract,and intra abdominal infection(all P＜0.05).Isolation rates of extended spectrum β-lactamase-producing/carbapenem-resistant Klebsiella pneumoniae,methicillin-resistant Staphylococcus aureus between HAI and CAI were all significantly different(all P ＜0.001).Conclusion Incidence of infection,infection sites,as well as constituent of pathogens and multidrugresistant organisms between HAI and CAI are varied,besides monitoring on HAI,monitoring on drug resistance of pathogens causing CAI should be paid attention,so as to provide scientific basis for rational antimicrobial use in clinical practice.
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Objective To investigate the current status of healthcare-associated infection (HAI),community-associated infection(CAD,and antimierobial use in hospitalized patients in medical institutions of Guizhou Province.Methods In September 2014,infection status of hospitalized patients in 174 second level hospitals and above in Guizhou Province were performed cross-sectional survey.Results A total of 68 419 patients were surveyed,the actual survey rate was 99.65％.1 581 patients developed 1 684 cases of HAI,HAI prevalence rate and HAI case prevalence rate were 2.31％ and 2.46％ respectively,18 571 patients developed 19 191 cases of HAI,CAI prevalence rate and CAI case prevalence rate were 27.14％ and 28.05％ respectively;patients in general intensive care unit(ICU) and pediatric department(non-neonatal group) had the highest HAI and CAI prevalence rates respectively.Constituent ratios of HAI and CAI sites was significantly different(x2 =17 325.44,P＜0.01);Escherichia coli was the main pathogen causing HAI and CAI.Utilization rate of antimicrobial agents on the survey day was 39.82 ％,ICU (80.47 ％) and pediatric department (76.67 ％) were the highest.Therapeutic antimicrobial use accounted for 67.48 ％ (n =18 386),single antimicrobial use accounted for 79.55 ％ (n =21 672).Pathogenic detection rate of specimens from patients receiving therapeutic antimicrobial agents was 31.76％.Conclusion This survey is helpful for understanding the high risk departments and sites of HAI and CAI in Guizhou Province,as well as pathogenic detection rate of specimens from patients receiving therapeutic antimicrobial agents,which provides basis for further prevention and control of HAI.
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Objective To analyze the difference in constituent and antimicrobial resistance of pathogens in commu-nity-associated urinary tract infection(CA-UTI)and healthcare-associated UTI(HA-UTI).Methods Clinical data and microbial detection of urine specimens of 960 patients with UTI in a hospital between January 2013 and June 2014 were investigated retrospectively,difference in constituent and antimicrobial resistance of pathogens were ana-lyzed.Results 403 cases were CA-UTI,and 557 were HA-UTI;pathogens in both CA-UTI and HA-UTI were gram-negative bacteria,accounting for 78.16% and 66.97% respectively.Constituent of pathogens in CA-UTI and HA-UTI were significantly different(χ2 =21 .68,P <0.001 ).Resistant rates of Escherichia coli to piperacillin /tazobactam,cefazolin,cefoperazone / sulbactam,aztreonam,meropenem,ertapenem,gentamicin,and compound sulfamethoxazole were all significantly different between CA-UTI and HA-UTI (all P <0.05);Except aztreonam, resistant rates of Escherichia coli in HA-UTI to the other antimicrobial agents were all higher than CA-UTI.Re-sistant rates of Enterococcus faecium in HA-UTI to penicillin,ampicillin,gentamicin,levofloxacin,ciprofloxacin, and moxifloxacin were all higher than CA-UTI(all P <0.05).Conclusion Constituent and antimicrobial resistance of pathogens in CA-UTI and HA-UTI are different,proper antimicrobial agents should be chosen according to con-stituent features of pathogens and change in antimicrobial resistance,so as to prevent and reduce the emergence of drug-resistant strains,and improve therapeutic effectiveness.
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Objective To analyze antimicrobial resistance of hospital-associated methicillin-resistant Staphylococ-cusaureus(HA-MRSA)and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA),and provide reference for clinical treatment and rational antimicrobial use. Methods From May 2013 to June 2014, Staphylococcus aureus in a hospital were collected and analyzed,strains were identified and performed antimicrobial susceptibility testing by using VITEK 2 Compact system,diagnosis of HA-MRSA and CA-MRSA were confirmed in combined with clinical symptoms.Results A total of 84 MRSA isolates were isolated (61 were HA-MRSA strains,23 were CA-MRSA).Resistant rates of HA-MRSA and CA-MRSA to penicillin G and oxacillin were both 100.00% ;to ampicillin/sulbactam was 100.00% and 95.65% respectively;to compound sulfamethoxazole was 39.34% and 34.78% respectively. Antimicrobial resistant rates of HA-MRSA to gentamicin,tetracycline,erythro-mycin,clindamycin,levofloxacin,ciprofloxacin,moxifloxacin,nitrofurantoin,and rifampicin were all higher than CA-MRSA,the difference were significant(all P<0.001).Conclusion Antimicrobial resistance of HA-MRSA and CA-MRSA are all serious,monitor should be intensified,antimicrobial use should be chosen according to antimicro-bial susceptibility testing result.
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Objective To analyze pathogen spectrum of intra-abdominal infection in patients in an intensive care unit (ICU).Methods Intra-abdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results 283 patients developed intra-abdominal infection,incidence of infection was 21.28%;133 (47.00%)patients were detected 186 isolates of pathogens,the proportion of gram-negative bacilli, gram-positive cocci,and fungi were 68.82%(n=128),28.49%(n= 53),and 2.69%(n=5)respectively.The major gram-negative bacilli were Escherichia coli ,Acinetobacter baumannii ,and Klebsiella pneumoniae ,the major gram-positive cocci were Enterococcus faecium,Staphylococcus aureus ,and Enterococcus faecalis .The detection rates of pathogens after patients stayed in ICU for ≤2,3-7,8-14,and>14 days were 70.43%(n=131),12.90%(n=24),10.22%(n=19), and 6.45%(n =12)respectively;Escherichia coli (n =51 )and Enterococcus faecium (n =21 )were the main pathogens when patients stayed in ICU for ≤48 hours,Acinetobacter baumannii was the main pathogen when patients stayed in ICU for >48 hours.Most intra-abdominal infection occurred after intestinal tract(53.23%)and hepatobiliary system operation (24.19%).39 (29.32%)patients isolated at least two kinds of pathogens,29 of whom isolated 2 kinds of pathogens. Conclusion Most pathogens of intra-abdominal infection in ICU patients are detected following intestinal tract and hepato-biliary operation,and mixed pathogens are common,predominantly gram-negative bacilli.Escherichia coli and Enterococcus faecium are the main pathogens when patients stayed in ICU for ≤48 hours,opportunistic pathogens are the main patho-gens when patients stay in ICU for >48 hours.
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Objective To investigate current status of healthcare-associated infection(HAI)and community-associated infection(CAI)of different levels of hospitals in Xinjiang.Methods Infection,antimicrobial use and pathogen detection in patients in second-class and above hospitals in Xinjiang on March 20,2014 were performed cross-sectional survey by bedside visiting and medical record reviewing methods.Results A total of 66 208 patients in 132 hospitals were investigated,HAI prevalence rate and case prevalence rate was 1.83% and 2.02% respectively;CAI prevalence rate and case prevalence rate was 24.53% and 24.83% respectively.HAI prevalence rate in third-class hospitals was higher than second-class hospitals (2.58% vs 1.44%,P <0.001),while CAI prevalence rate was lower than second-class hospitals (17.84% vs 28.01%,P<0.001).HAI prevalence rate was highest in intensive care unit (14.91%),CAI was highest in pediatric department. The common infection sites were respiratory tract,surgical site and urinary tract.Antimicrobial usage rate was 31.27%, antimicrobial usage rate in second-class hospitals was higher than that of the third-class hospitals([35.95%,n=15 642]vs [22.32%,n=5 064],χ2 =1 288.974,P <0.001),pathogen detection rate in third-class hospitals was higher than that of the second-class hospitals([59.40%,n=2 224]vs [53.59%,n=6 436],χ2 =38.964,P <0.001 )Gram-negative bacilli were main isolated pathogens,the top 3 pathogens were Escherichia coli ,Klebsiella pneumoniae ,and Acinetobacter bau-mannii .Conclusion The cross-sectional survey can reflect infection status of different levels of hospitals,surveillance of targeted microbial detection and rational antimicrobial use should be strengthened,management of infection in high risk population and key sites should be paid close attention.
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Objective To analyze the types and risk factors of community-acquired infections (CAI)in diabetic patients by system analysis method of evidence-based medicine.Methods China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database were searched by computer,domestic published researches on CAI and related risk factors in dia-betic patients were aggregated,Meta-analysis was conducted by stata 1 1 .0 software.Results A total of 1 2 literatures were included in the study .The average rate of CAI in diabetic patients was 39.55% (22.12%-55.86%).The major infec-tions were respiratory system infection(40.74%),urinary tract infection(27.35%),tuberculosis(10.80%),skin and soft tissue infection(9.19%),and hepatobiliary system infection (5.57%).Stratified analysis on risk factors revealed that OR and OR95%CI of chronic complication,age,disease course,glycemic control,gender,type of diabetes,subtype of ketoac-idosis was 1.63(1.45,1.82),1.30(1.19,1.42),1.47(1.35,1.61),0.68(0.61,0.76),0.69(0.64,0.75),1.37 (1.13,1.66 )and 0.87(0.62,1.23),respectively.There was no publication bias and combined results were stable. Conclusion The main CAI in diabetic patients are respiratory system infection,urinary tract infection,tuberculo-sis,skin and soft tissue infection,and so on ;several factors,such as female,older age,long-term disease course, poor glycemic control,and complication,can contribute to the increase of CAI in diabetic patients.
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Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) genes have recently emerged worldwide, but infections due to PVL carrying CA-MRSA strains have never been reported in Korea. We report a case of extensive perianal abscess due to PVL+ CA-MRSA in a 76-year-old Korean female patient, of which genetic background was very close to USA300. It belonged to staphylococcal cassette chromosome mec element (SCCmec) type IV, ST8 of multilocus sequence typing (MLST), type 1 spa type, and accessory gene regulator locus (agr) group I. Comprehensive literature reviews from the Far East showed molecular characteristics were diverse and PVL genes were infrequently found than in western countries.
Subject(s)
Aged , Female , Humans , Abscess , Bacterial Toxins , Exotoxins , Asia, Eastern , Korea , Leukocidins , Lifting , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Multilocus Sequence Typing , Staphylococcus aureusABSTRACT
Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) genes have recently emerged worldwide, but infections due to PVL carrying CA-MRSA strains have never been reported in Korea. We report a case of extensive perianal abscess due to PVL+ CA-MRSA in a 76-year-old Korean female patient, of which genetic background was very close to USA300. It belonged to staphylococcal cassette chromosome mec element (SCCmec) type IV, ST8 of multilocus sequence typing (MLST), type 1 spa type, and accessory gene regulator locus (agr) group I. Comprehensive literature reviews from the Far East showed molecular characteristics were diverse and PVL genes were infrequently found than in western countries.