Investigation on the status of healthcare-associated infections among 42 429 inpatients in Wuhan City / 公共卫生与预防医学

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.

Methicillin-resistant Staphylococcus aureus intracranial abscess: An analytical series and review on molecular, surgical and medical aspects

Purpose: Intracranial abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) is rare and unexplored. The aim of the present study is to examine the prevalence, clinical and molecular characteristics, treatment options and outcome of MRSA intracranial abscess over a period of 6 years. Patientsand Methods: A total of 21 patients were included in this retrospective study. The demographic and clinical details of all the patients were collected. Molecular typing including staphylococcal cassette chromosome mec typing, spa typing and polymerase chain reaction of Panton–Valentine leucocidin toxin (PVL) gene for the latter 6 isolates was performed. Results: The paediatric population was the most affected group (33.3%). The primary route of infection was post-operative/trauma in 7 (33.3%) cases. All the patients were treated surgically either by aspiration or excision. Fifteen (71%) patients received anti-MRSA treatment with vancomycin or linezolid, where linezolid-treated patients showed better prognosis. Of the 11 patients who were on follow-up, unfavourable outcome was observed in 3 (27.3%) cases and 8 (72.7%) cases improved. The molecular typing of six isolates revealed four community-associated (CA) MRSA, one each of livestock-associated (LA) and healthcare-associated MRSA with PVL gene noted in all. Conclusion: We propose that timely diagnosis, surgical intervention and appropriate anti-MRSA treatment would contribute to better outcome. The occurrence of CA-MRSA and LA-MRSA infection in the central nervous system signifies the threat from the community and livestock reservoir, thus drawing attention towards surveillance and tracking to understand the epidemiology and implement infection control measures.

Evaluation of Methicillin-Resistance Rates among Community-associated Staphylococcus aureus Infections in Korean Military Personnel

To evaluate methicillin-resistance (MR) rates among community-associated (CA) Staphylococcus aureus infections in the Korean military, we screened electronic medical records of 223 patients with S. aureus infection in a military referral hospital from 2012 to 2017. During the study period, MR rates did not change annually, and were not different between officers and conscripted personnel. Among conscripted personnel, MR rates in CA S. aureus infections did not increase with longer duration of military service, both in trend analysis and multivariate analysis. In conclusion, MR rates among CA S. aureus infections did not increase during military service in Korea.

Clinical features of hypervirulent Klebsiella pneumoniae bloodstream infection / 中国感染控制杂志

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.

Prevalence rates of healthcare-associated infection and community-associated infection in hospitalized patients in 253 hospitals of Hebei Province / 中国感染控制杂志

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.

Prevalence rates of healthcare-and community-associated infection in hospitalized patients in medical institutions of Guizhou Province, 2014 / 中国感染控制杂志

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.

Effect of antimicrobial use density on antimicrobial resistance rate of healthcare-associated Staphylococcus aureus half a year later / 中国感染控制杂志

Objective To explore the effect of antimicrobial use density (AUD) on the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and antimicrobial resistance rate of healthcare-associated Staphylococcus aureus (HA-SA) half a year later.Methods From 2012 to 2015,all types of AUD,detection rate of MRSA,and antimicrobial resistance rate of HA-SA were calculated semiannually,correlation between antimicrohial resistance rate of HA-SA and all types of AUD in the same first half of year were analyzed with correlation analysis and multiple linear regression.Results From the first half of 2012 to the latter half of 2015,the total AUD declined from 128.2 to 49.0,except the AUD of carbapenems rose,AUD of other antimicrobial agents declined.From the latter half of 2012 to the latter half of 2015,104 249 patients were admitted to the hospital,and 1 008 strains of SA were isolated from 40 884 specimens,857 (85.02％) of which were community-associated SA(CA SA) and 151 (14.98％) were HA-SA.Isolation rate of HA-MRSA declined from 31.25％ in the latter half of 2012 to 12.50％ in the latter half of 2015;isolation rate of CA-MRSA rose from 7.08％ to 16.08％,resistance rate of HA-SA was generally higher than that of CA-SA.Antimicrobial resistance rate of HA-SA to ciprofloxacin remained the same,to levofloxacin increased,to 8 other antimicrobial agents all declined;resistance rates of CA-SA to oxacillin,ciprofloxacin,clindamycin,gentamicin,and levofloxacin increased,but to other antimicrobial agents declined;no SA strains was found to be resistant to vancomycin and linezolid.The resistance rate of HA-SA to azithromycin and erythrocin was correlated with the AUD of macrolides,resistance rate of HA-SA to clindamycin was correlated wvith the AUD of aminoglycosides,to gentamicin was correlated with the AUD of macrolides and the total AUD.Conclusion The selective pressure of antimicrobial agents is still the important cause of the occurrence of antimicrobial resistance,decreasing the AUD of antimicrobial agents will help for reducing the detection rate of HA-MRSA and drug resistance rate of HA-SA.

Prevalence rates of healthcare-associated infection and community-associated infection in hospitalized patients in Wuhan City / 中国感染控制杂志

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.

Reserch Progress of USA300 Clone of Community-Associated Methicillin-Resistant Staphylococcus Aureus / 现代检验医学杂志

Community associated methicillin-resistant Staphylococcus aureus is a human pathogen.It can cause a series of infections cause morbidity and mortality,including bacteremia,pneumonia and soft tissue infections.USA300 clone is highly toxic and contagious.Its prevalence in the United States continues to rise,and has begun to spread to the rest of the world.This article briefly reviews the recent research on relevant aspects of molecular epidemiological characteristics,grug resistance mechanisms and treatment of USA300 clone.

Multicenter study on the molecular characteristics of community-associated Methicillin-resistant Staphylococcus aureus in children with skin and soft tissue infection / 中华实用儿科临床杂志

Objective To explore the molecular characteristics of community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) from children with skin and soft tissue infection (SSTIs) in China.Methods CA-MRSA was collected from the outpatients in Department of Dermatology in 13 Children's Hospitals of China.Genotypic characteristics of CA-MRSA isolates were tested by adopting mnltilocus sequence typing (MLST),staphylococcal protein A (spa) typing and Staphyloccoccal cassette chromosome mec (SCCmec) typing.And the presence of Panton-Valentine leukocidin genes(pvl) was determined also.Results Overall,1 705 strains of Staphylococcus aureus were isolated from SSTIs children,and CA-MRSA accounted for 2.6％ (44/1 705 strains).Two types of SCCmec were detected in all the CA-MRSA strains,and the main types were SCCmec Ⅳ and SCCmec Ⅴ,accounting for 45.5 ％ (20/44 strains) and 54.5 ％ (24/44 strains),respectively.Thirteen MLST types (STs) and 15 spa types were detected among CA-MRSA.The most prevalent MLST was ST121 (18/44 strains,40.9％),followed by ST59 (9/44 strains,20.5％).Additionally,t437 was predominant,accounting for 40.9％ (18/44 strains).ST121 strain had 8 spa types,and t2086 was the most common type (6/18 strains,33.3％);while ST59 had only 1 spa type,t437.No ST121,ST59 and t437 strains were found in Central and Eastern region of China.Only 4 (9.1％) of the 44 CA-MRSA strains harbored pvl genes which were all from Southern region.Conclusions The most common clone of SSTIs CA-MRSA in children is MRSA-ST121-SCCmec Ⅳ/Ⅴ,as the molecular epidemiology of CA-MRSA strain has changed,ST121 has replaced ST59 to become the main epidemic strains.

Staphylococcus aureus resistente a meticilina asociado a la comunidad (SARM-AC): comunicación de los primeros cuatro casos pediátricos descritos en Hospital de Niños Roberto del Río / Community associated-methicillin-resistant Staphylococcus aureus (SAMR-AC): comunication of the first four pediatric cases in the Roberto del Rio Children's Hospital

Staphylococcus aureus is a known pathogen in pediatric patients that produces skin infections, cutaneous abscess, cellulitis and osteoarticular infections. Most of these infections are produced by a meticilin susceptible strain. The community associated methicillin resistant Staphylococcus aureus was published for the first time in 1993, ever since then is has been recognized as a cosmopolite pathogen. The first report in Latin America was published in 2003, and in Chile in 2008 from adult patients that have reported traveling to other countries. The following series describes four pediatric cases, all school-aged children, diagnosed since 2012 with clinical followups and molecular studies. Two cases presented as osteomyelitis of the lower extremity; and one presented as arm cellulitis. These three cases had Panton Valentine leukocidine (PV-L) negative strains from the clone complex 8. The last case presented a renal abscess, the strain was PV-L positive from the clone complex 30. This case series constitutes the first pediatric case report in Chile.

Staphylococcus aureus es un patógeno conocido como causa de infecciones de piel, tejidos blandos, osteoarticulares y celulitis en niños. Estas infecciones son principalmente causadas por cepas sensibles a meticilina. Staphylococcus aureus resistente a meticilina asociado a la comunidad fue publicado por primera vez en población australiana nativa en 1993 y desde entonces se ha transformado en un patógeno cosmopolita. En Latinoamérica se publicó el primer caso en 2003 y en Chile se comunicaron los primeros casos en 2008, casi todos adultos y con antecedentes de viaje al extranjero. Nuestra serie describe cuatro casos clínicos en niños escolares, pesquisados desde el 2012 con seguimiento clínico y estudio molecular. Dos casos se presentaron como una osteomielitis de extremidad inferior y uno como una celulitis de brazo. Los tres primeros casos correspondieron a cepas leucocidina Panton Valentine (PV-L) negativa, del complejo clonal 8. El último caso fue un absceso renal, cepa PV-L positiva, perteneciente al complejo clonal 30. Esta serie es el primer reporte de casos pediátricos en Chile.

Molecular epidemiology of methicillin resistant staphylococcus aureus colonizing the anterior Nares of school children of Udupi Taluk.

Context: Community associated methicillin resistant Staphylococcus aureus (CA‑MRSA) cause serious skin and soft tissue infections including necrotizing fasciitis and necrotizing pneumonia. Production of Panton Valentine Leucocidine (PVL) toxin is implicated in its enhanced virulence. A variant of epidemic MRSA‑15 (EMRSA‑15) which produces PVL toxin has been isolated and characterized by pulsed-field gel electrophoresis (PFGE) method from the Indian population both in hospital and community settings. Aims: Identify the epidemiological type of MRSA colonizing the anterior nares of school children in Udupi taluk. Settings and Design: The study population included children of the age group of 5-16 years belonging to the Udupi taluk of Karnataka, India. A total of 1503 children were screened for MRSA colonization during July 2009 to December 2010. Materials and Methods: PVL assay, Staphylococcal Cassette Chromosome (SCC) mec typing and PFGE typing were carried out with all the MRSA isolates. Statistical Analysis Used: Frequency distribution of different variables was assessed by SPSS. Results: Among the 1.1% of MRSA, 58.8% (10/17) of isolates were positive for pvl and 41.7% (7/17) were identified as SCC mec type IV. PFGE patterns of all the strains were identical with Indian variant EMRSA‑15; however they were different from classical EMRSA‑15 in 3-4 bands. Conclusions: The Indian variant EMRSA‑15 gains much epidemiological relevance owing to the acquisition of pvl gene. In spite of low prevalence of nasal colonization of MRSA, emergence of the virulent Indian variant EMRSA‑15 in our community is a worrisome fact to be reckoned with.

Molecular Characterization of Community-Associated Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Children with Skin Infections in Busan, Korea

The prevalence and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-susceptible S. aureus (CA-MSSA) from children with skin infection were investigated by staphylocoagulase (SC) typing, multilocus sequence typing (MLST), SCCmec typing and virulent toxins, including Panton-Valentine leucocidin (PVL), and exfoliative toxins (ET). Among 69 cases of CA-S. aureus for a 3 month period from March to June, 2014 at hospital in Busan, 28 (40.6%) were MRSA and 41 (59.4%) were MSSA. Of the 28 CA-MRSA isolates, two major clones were identified as SC type Vb-ST72-SCCmec type IV (53.6%) and SC type l-ST89-SCCmec type II variant (42.8%), and the remaining one (3.6%) was SC type lll-ST8-SCCmec type IV. In CA-MSSA, the prevalent clone was SC type Vb-ST72 (29.3%), followed by SC type Vb-ST188 (21.9%), SC type Va-ST121 (19.5%) and SC type lV-ST30 (9.6%). None was positive for PVL gene, and all of the SC type l-ST89-SCCmec type II variant clones were ETB gene positive. The data suggest that there are significant clonal relatedness with specific SC types, and genetic diversities in both community strains isolated from children with skin infections.

Pathogen spectrum of intra-abdominal infection in patients in intensive care unit / 中国感染控制杂志

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.

Epidemiological cross-sectional investigation on healthcare-associated in-fection of 132 hospitals in Xinjiang in 2014 / 中国感染控制杂志

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.

Pathogens and antimicrobial resistance in community-associated and healthcare-associated urinary tract infection / 中国感染控制杂志

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.

Difference in antimicrobial resistance between hospital- and community-associated methicillin-resistant Staphylococcus aureus / 中国感染控制杂志

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.

Community-acquired infections and risk factors in patients with diabetes:A Meta-analysis / 中国感染控制杂志

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.

Characterization of Community-Associated Methicillin-Resistant Staphylococcus aureus in Gwangju, Korea

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens worldwide. This study was performed to investigate the characterization of MRSA isolated from healthy persons in Gwangju area. A total of 404 nasal swab samples was collected during October 2011 and May 2012 in Gwangu, Korea. A survey on MRSA was conducted with meat distributors (n=230), pre-school children (n=108), officers (n=66), respectively. To confirm the MRSA, polymerase chain reaction (PCR) for the S. aureus specific gene and mecA gene was performed. A total of 34 (8.4%) MRSA isolates was isolated from 404 nasal swab samples: 6.1% (14/230) from meat distributors, 16.7% (18/108) from pre-school children, and 3.0% (2/66) from officers samples, respectively. The most prevalent antimicrobial resistance observed in the MRSA isolates was to ampicillin 100% (34/34), followed by penicillin 97.1% (33/34), oxacillin 94.1% (32/34) and erythromycin 52.9% (18/34). All MRSA isolates were then characterized by panton-valentine leukocidin (pvl) gene detected by PCR, staphylococcal cassette chromosome mec (SCCmec) typing, and pulsed-field gel electrophoresis (PFGE) with Sma I digestion. 34 MRSA isolates from nasal carriage were pvl gene negative, SCCmec type IV; 73.5% (25/34), type II; 17.6% (6/34), type III; 2.9% (1/34), and untypable; 5.9% (2/34), respectively. 34 MRSA isolates showed 16 PFGE patterns. These results indicated that isolation rates of community-associated methicillin-resistant S. aureus (CA-MRSA) from healthy persons were low (8.4%), but continuous surveillance and monitoring should be performed to prevent the spread of MRSA in the community.

Scarlet Fever Caused by Community-associated Methicillinresistant Staphylococcus aureus.

We describe a previously healthy 2½-year-old boy with staphylococcal scarlet fever associated with acute suppurative otitis media due to community-associated methicillin-resistant Staphylococcus aureus. The patient was successfully treated by spontaneous drainage in combination with trimethoprim-sulfamethoxazole therapy.