Investigation on a suspected outbreak of carbapenem-resistant Acinetobacter baumannii nosocomial infection in an intensive care unit / 上海预防医学

ObjectiveTo investigate a suspected outbreak of carbapenem-resistant Acinetobacter baumannii （CRAB） nosocomial infection in an intensive care unit （ICU） and provide scientific evidence for prevention and control of multi-drug resistant nosocomial infection. MethodsClinical and epidemiological data of 4 patients with CRAB infection were retrospectively investigated in the ICU of Renji Hospital in November 2021. Environmental hygiene monitoring and multilocus sequence typing （MLST） were conducted and intervention measures were taken. ResultsA total of 4 cases with CRAB infection were identified， among which 1 case was determined to be community-acquired and3 cases were hospital-acquired. The isolated strains shared the same drug resistance， and were all classified into ST368 type. In the surface and hand samples （n=40）， 2 CRAB strains were detected in the air filter beside the bed of the first case， with a detection rate of 5%. After adopting comprehensive prevention and control strategies， including environmental cleaning and disinfection， hand hygiene， staff management and training， and supervision， no similar case with CRAB infection was found. ConclusionThis suspected outbreak of CRAB nosocomial infection may be induced by inadequate environmental cleaning and disinfection， and inadequate implementation of hand hygiene. Timely identification， investigation， and targeted measures remain crucial to effective control of possible nosocomial infection.

Trends in antimicrobial use and hospital infection incidence among inpatients / 上海预防医学

ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.

Survey on the testing accuracy of HBV serological markers among grassroots medical institutions in the demonstration areas of infectious diseases / 中华临床感染病杂志

Objective:To evaluate the detection accuracy of hepatitis B virus (HBV) serological markers among grassroots medical institutions in the demonstration areas of infectious diseases.Methods:A fixed sampling method was used among the followed-up hepatitis B cohort in general population of six infectious disease demonstration areas nationwide. Blood samples of chosen objects were collected, in which HBsAg and anti-HBs were tested by grassroots medical institutions and were also parallely tested by the third-party platform. The test results were compared between the two groups. Statistical analyses were conducted by SAS 9.4 software.Results:A total of 5 756 and 5 263 samples of HBsAg and anti-HBs were successfully tested, respectively. Comparing the results of HBsAg and anti-HBs from grassroots medical institutions with the results from the third platform, the agreement of HBsAg and anti-HBs was 97.13% and 77.33%, respectively. The Kappa value was 0.56 (95% CI 0.50-0.62) for HBsAg and 0.54 (95% CI 0.52-0.56) for anti-HBs, respectively; and the McNemar tests indicated the difference between the results (all P<0.01). There were also significant differences in agreement of testing results with the third platformin among different regions ( P<0.05 or <0.01). The Kappa values indicated that Jiangsu province and Guangdong province had high accordance rates of HBsAg (0.87 and 0.81, respectively), and Gansu province and Guangdong province had high accordance rates of anti-HBs (Both were 0.74). Regarding the results from the third platform as the standard, the sensitivity of HBsAg testing in grassroots medical institutions was moderate (40.51%) and the specificity was well (99.96%). The sensitivity of anti-HBs testing was substantial (73.18%) and the specificity was well (84.31%). Guangdong province (Youden index: 0.69) and Jiangsu province (Youden index: 0.80) had high identification ability for HBsAg, and for indicator of anti-HBs, Gansu province (Youden index: 0.78) and Guangdong province (Youden index: 0.76) had high identification ability. Conclusion:There are certain differences in results of HBV serological markers tests between the grassroots medical institutions in the demonstration areas of infectious diseases and the third platform. Current testing strategies in grassroots medical institutions are suitable for identifying people without hepatitis B infection, while it is necessary to pay attention to the situation of potential false negative error.

Effects of community TCM health management on patients with chronic obstructive pulmonary disease at a stable stage / 中华健康管理学杂志

Objective:To observe the effects of community traditional Chinese medicine (TCM) health management of patients with chronic obstructive pulmonary disease (COPD).Methods:From June 2017 to June 2018, 79 patients were selected as study subjects. These patients were randomly divided into two groups. The TCM management group had 39 patients (of which 26 were male), with an average age of (70.77±5.91) years and the course of disease of (7.97±3.12) years. The control group had 40 patients (of which 25 were males), with an average age of (70.60±5.93) years and the course of disease of (7.70±3.01) years. Both groups were given conventional western medicine treatment. The TCM management group was administered TCM health management for 1 year on the basis of the conventional western medicine treatment. This management included establishing electronic archives for COPD patients, Hu Xi Tu-Na, Baduanjin, acupoint massage, acupoint plaster, and dietary guidance according to the TCM physique identification. Management and follow-up of patients was continuous. The TCM syndrome score, CAT score, number of acute exacerbations, and lung function of COPD patients were recorded before and after 1 year of treatment.Results:In the TCM management group, there were 6 cases of clinical control, with 8 and 19 cases displaying obvious and effective effects, respectively. The total effective rate was 84.61%. In the control group, there were 2 cases of clinical control, with 3 cases and 25 cases displaying obvious and effective effects, respectively. The total effective rate was 75.00%. The curative effect of the TCM syndrome in the TCM management group was better than that in the control group. In the TCM management group，the CAT score was (7.46±3.28) points and the number of acute exacerbations was (4.21±2.61) times, the forced expiratory volume (FEV 1) in the first second was (1.99±0.79) L, and the forced vital capacity (FVC) was (2.63±0.92) L. In the control group, the CAT score was (10.38±4.68), the number of acute exacerbations was (6.03±3.00), FEV 1 was (1.66±0.65) L, and FVC was (2.41±0.81) L. The CAT score and the number of acute exacerbations in the TCM management group decreased, while the number of FEV 1 increased, which was statistically significant compared to the control group. Conclusion:Community TCM health management can improve the symptoms of COPD patients at a stable stage, reduce the number of acute exacerbations, and improve lung function.

Progress and prospects of quadrivalent influenza vaccine / 中华临床感染病杂志

Although the flu vaccine is the most effective strategy for preventing influenza currently,the population incidence and mortality of influenza present an unstable trend.Due to the rapid variability of influenza virus,the conventional flu vaccine components and dominant lineage are not matching;more importantly,trivalent influenza vaccine (T IV) contains only A/H3N2,A/H1N1 and B/Victoria lineage,which does not match the B/Yamagata lineage that have prevailed in recent years.Quadrivalent influenza vaccine (QIV) adds the B/Yamagata lineage,and it has been used abroad for susceptible populations.Compared with TIV,QIV provides better protection for susceptible populations and is considered to have better public health benefits.This article reviews the history of development and current status,the safety,immunogenicity,efficacy of prevention and control and cost-effectiveness of QIV,to provide reference for the promotion and implementation of influenza vaccination.