ObjectiveTo explore the current status of nursing researches about catheter-related infections in recent 5 years in China, and provide reference for further research.MethodsThe China National Knowledge Infrastructure database and Wangfang database were selected to search for literature about catheter-related infections published in recent 5 years in 10 nursing journals of Statistic Source, with the terms of " catheter-related bloodstream infection” or " ventilator-associated pneumonia” or " catheter-related urinary tract infection”. Statistical analysis was conducted.ResultsA total of 216 papers were included. The number of papers was not increased year by year. In terms of the object of study, the studies on ventilator-associated pneumonia were the most, accounting for 71.3%. Only 36.5% of the studies had accurate diagnostic criteria. In terms of the type of study, experimental studies were the most (109 articles). The content was concentrated on the best practice intervention studies (149 articles). The data collection methods gave priority to active surveillance/screening, including 113 articles.ConclusionsThe present focused attention is not enough to the researches about catheter-related infections in nursing field, and rigorous design is lacking in published studies. There are only a few nursing studies about catheter-related infections with high quality and high level of evidence. The quantity and quality of nursing researches about catheter-related infections still need to be improved. Nurses should pay more attention to the control and prevention of catheter-related infections, and should improve their research capacity.
ObjectiveTo analyze the trend of hospital infection, so as to provide a scientific basis for hospital infection prevention and control. MethodsFrom 2011 to 2013, according to the criteria of diagnosis of nosocomial infections set up by the Ministry of Health, the prevalence rates of nosocomial infections in patients who were hospitalized on the survey day were investigated by the combination of bedside investigation and medical records checking. ResultsThe incidence rates of nosocomial infections from 2011 to 2013 were 2.99%, 2.31% and 1.95%, respectively, presenting a downward trend. The rate of hospital infection was the highest in comprehensive Intensive Care Unit, and the main infection site was the lower respiratory tract. Gram-negative bacteria were the main pathogens causing hospital infections, including Klebliella pnermoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and Escherichia coli. The utilization rates of antibacterial agents in these three years were respectively 39.84%, 34.58% and 34.22%. ConclusionTargeted surveillance and management of key departments and sites should be strengthened. It is necessary to strengthen the surveillance and management of antibiotics, raise the submission rate of pathogens, and use antibiotics appropriately.
Objective To analyze the effective measures to intercept the infection chain of Severe Acute Respiratory Syndrome (SARS), and to study the effective methods for prevention and control. Methods A total of 17 clinically diagnosed SARS cases, 6 suspect cases and 202 people closely contacted with case were dealt with differently according to appropriate criteria, and 144 medical staff was given timely safety measures. Results One of seventeenth cases was diagnosed after its death, and the rest were isolated and treated, and among them 1 died, 9 were cured, and 6 were improved obviously. Six suspect cases were separated and treated in hospital, 5 were cured and 1 improved obviously. Among 202 closely contacted people there were no the secondary infected cases, and neither among all the related medical staff and other people. Conclusion To analyze seriously the infection chain and take effective and feasible interceptive measures are the best approach to prevent and control the spread of SARS and avoid the occurrence of the secondary infected cases.
ObjectiveTo summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection. MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment. ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure. ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
摘要:目的: 观察急性链球菌感染后肾炎(APSGN)患儿血压变化规律。 方法 :观察15例重型APSGN(重型组)和20例普通型APSGN(普通组)患儿病程中各时期血压及尿量变化,并进行免疫和生化指标对比。 结果 :APSGN患儿高血压总共26例(7429%),其中重症组高血压14例(933%),普通组高血压12例(60%),高血压发生率重症组高于普通组〖WTBX〗P lt;005。重症APSGN患儿入院时舒张压、少尿期收缩压舒张压、多尿期舒张压与普通组比较均有显著性差异,〖WTBX〗P lt;005;而且重症APSGN与普通组在少尿期持续时间、尿量、多尿期持续时间、尿量的指标比较也均有显著性差异,〖WTBX〗P lt;005。重症APSGN患儿血IgG、BUN、Cr明显高于普通APSGN,Plt;005。 结论 :高血压是APSGN主要临床表现之一,血压增高多发生于少尿期,但重症APSGN患儿于多尿期出现血压增高的第二次高峰,临床上应注意监测,及时治疗。Abstract: Objective: To observe the law of the changes of children’s blood pressure after the infection of steptococcus with acute nephritis(APSGN).〖WTHZ〗Methods :Watching 15 cases of serious APSGN and 20 cases of ordinary APSGN for their changes in blood pressure and their urine amounts in various periods; contrasting their indexes in immunity and biochemistry.〖WTHZ〗Results :Among 26cases(7429%)of patients’high blood pressure with APSGN,of which 14cases (933%)are serious ones and 12cases (60%)are ordinary ones,the occurrence rate of the serious group is higher than that of the ordinary group, Plt;005At the initial stage, either the diastolic presssure or the diastolic pressure and the systolic pressure of the serious group with a small amount of unine, the diastolic pressure with a large amount of urine are evidently different from those of the ordinary group, Plt;005Furthermore,there are evident differences in the durations and amounts of urine with either a small or a large amount of urine, Plt;005The IgG,BUN and Cr of the serious group are evidently higher than those of the ordinary group,Plt;005 Conclusion :High blood pressure is one of the main clinical manifestations of APSGN.The increase of blood pressure mostly occurs during the period of a small amount of urine, but a second summit of high blood pressure with APSGN mostly appears in the period of a large amount of urine.It must be closely observed and therefore given the timely treatment.
ObjectiveTo explore the clinical features, etiological characteristics of co-infections in adult patients with rhinovirus pneumonia.MethodsFourty-nine patients admitted to hospitals for rhinovirus pneumonia were enrolled from 8 medical centers in mainland China between August 2016 and August 2018. Multiplex real-time polymerase chain reaction assays for viral detection were implemented to all bronchoalveolar lavage fluid specimens obtained from the patients. The patients were divided into two groups depending on the status of other etiology co-infection (simple rhinovirus pneumonia group, n=24; coinfections group, n=25). The general data were collected, age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, whether patients with respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate of the two groups were reviewed and compared in detail.ResultsThirteen patients (26.5%) with rhinovirus pneumonia had no underlying diseases, 8 patients (16.3%) with chronic underlying lung diseases, 6 patients (12.2%) with diabetes mellitus, 10 patients (20.4%) were immunocompromised patients, 16 patients (32.7%) with respiratory failure, and the hospital mortality rate was 8.2% (4/49). Cases with coinfection were remarkably correlated with more cerebrovascular diseases and disturbance of consciousness, higher PSI score and higher ratio of CURB-65 score >1, more respiratory failure and hospital mortality than those of simple rhinovirus pneumonia group (P< 0.05). There were 25 cases (51.0%) with mixed infection, including 18 bacteria (36.7%), 12 viruses (24.5%), 12 (24.5%) fungi (pneumocystis, aspergillus). Enterobacter and Pseudomonas aeruginosa were most frequently identified bacteria in the viral-bacterial group. Four patients with coinfections died.ConclusionsRhinovirus pneumonia in adult patients often has underlying diseases, and is prone to coinfections (bacteria, fungi, and other viruses). The outcome of these patients is always poor.
Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
呼吸道感染在感染性疾病中占有重要地位，细菌性肺炎是呼吸道感染中的主要代表性疾病，最重要的治疗措施是抗菌治疗，用药选择及方法正确与否直接影响治疗的成败。同时如何降低医疗费用也是临床医生需要考虑的棘手问题。据国外文献报道在英国每年约有5亿张以上的抗微生物药物处方，其中住院处方中约40％为静脉制剂，而我国住院静脉制剂的处方比例则更高。医疗费用的增加部分与静脉用药过多有关。为寻求解决临床治疗与医疗费用之间的矛盾，选择高效、低毒、廉价的抗菌药物，1987年Quintiliani等[1]首先提出了抗生素序贯疗法（sequential therapy）的概念，即在经过相对短疗程（48～72 h）静脉抗菌药物治疗，临床症状基本稳定或改善后，改为口服抗菌药物治疗。口服的抗菌药物可以是与前者完全相同的口服剂型，也可以是同一类或抗菌谱相似的同一级药物，后也有人称之为"转换治疗"（switch therapy）、"降级治疗"（step-down therapy）。据国外文献报道，住院的社区获得性肺炎（CAP）应用序贯疗法者因早期出院每位患者节约费用293~1393美元[2-4]。
摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.