Knowledge of“Guidelines for the prevention of intravascular catheter-related infections(2011)”:A survey of intensive care unit nursing staffs in China

Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'knowledge and to explore the barriers to adherence to evidence-based guidelines in clinical practice in China.Methods:Cross-sectional surveys were carried out in Chinese ICUs from January 2013 to March 2014.The nurses'demographic information,knowledge of the guidelines,and barriers to adherence were assessed by a validated questionnaire and then analyzed statistically.Results:The questionnaires were completed by 455 ICU nurses from 4 provinces of China.The mean score was 8.17 of 20,and higher scores were significantly associated with province,years of experience,and years of ICU experience.Forty-nine(10.7%)nurses had not heard of the guidelines,whereas 231(50.7%)nurses heard of the guidelines but did not receive training for them.Trained nurses'scores were higher than untrained nurses'scores.The three main barriers to compliance with the guidelines were an unfamiliarity with them,an excessive workload due to a shortage of nurses,and a lack of training.Conclusions:ICU nurses'knowledge of the updated guidelines is quite low,which could be a potential risk factor for patient safety.Multidisciplinary interventions and continuous.

Catheter-related infections caused by Mycobacterium abscessus in a patient with motor neurone disease:A case report

BACKGROUND Mycobacterium abscessus(M.abscessus)is a rapidly growing mycobacterium and ubiquitous in the environment,which infrequently causes disease in humans.However,it can cause cutaneous or respiratory infections among immunocompromised hosts.Due to the resistance to most antibiotics,the pathogen is formidable and difficult-to-treat.CASE SUMMARY Here,we present a case of catheter-related M.abscessus infections in a patient with motor neurone disease.Catheter and peripheral blood cultures of the patient showed positive results during Gram staining and acid-fast staining.The alarm time of catheter blood culture was 10.6 h earlier than that of peripheral blood.After removal of the peripherally inserted central catheter,secretion and catheter blood culture were positive.M.abscessus was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and 16S rDNA sequencing.CONCLUSION For catheter-related M.abscessus infection,rapid diagnosis and timely and adequate antimicrobial therapy are crucial.

Analysis of the relationship between deep venous catheter-related infection and post-operative complications in patients receiving minimally invasive esophagectomy

Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.

Prevention of central venous catheter-related infection in ICU with cluster nursing intervention: a meta-analysis

Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was searched from China National Knowledge Internet(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),Chinese Biomedical Literature Service System(SinoMed),PubMed,Embase and Cochrane library databases from the establishment to May 1,2020.Two reviewers independently evaluated and cross checked the quality of the study.Revman 5.3 was used to conduct the meta-analysis.Results:A total of 21 randomized controlled trials with 6,030 patients were included.Meta-analysis showed that the incidence of central venous catheter-related infection(relative risk(RR)=0.29,95%confidence interval(CI)[0.23,0.37]),the incidence of catheter plugging(RR=0.25,95%CI[0.16,0.39])and catheter prolapse(RR=0.18,95%CI[0.11,0.29])were significantly different between the two groups.Conclusion:Cluster nursing intervention could prevent central venous catheter-related infection in intensive care unit.

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 +/- 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 +/- 11.2 d) and the traditional secondary suturing group (36.2 +/- 15.3 d) (P < 0.05). Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

基于气味理论探讨苏黄止咳汤在感染后咳嗽中的运用

感染后咳嗽(Post-infectious cough,PIC)是一种亚急性咳嗽,发病时主要表现为咳嗽症状持续存在,并无器质性病变。临床中部分感染后咳嗽患者运用常规的散寒、清热或润燥等方法不能取得预期的疗效,晁恩祥国医大师结合多年临床经验,将此类感染后咳嗽患者归为风咳,指出其核心病机为“风邪犯肺、肺气失宣”,治疗上应遵循“疏风宣肺、止咳利咽”的治则。陈生教授作为晁恩祥国医大师的学术传承人,在临床中针对此类患者治疗时多选用晁恩祥国医大师所创苏黄止咳汤加减。郝小梅教授将气学说归纳为自然之气、人体之气、病邪之气和药食之气,味学说即五味理论。本文从气味理论的角度分析了苏黄止咳汤在此类感染后咳嗽患者中的应用。方中用药部位包括叶、根茎及果实等,强调了天地二气交感的重要性,全方寒温并用,辛苦并施,宣降同调,组方严格遵守气味理论,共奏疏风宣肺,止咳利咽之效,疗效显著。

Prevention of catheter-related Pseudomonas aeruginosa infection by levofloxacin-impregnated catheters in vitro and in vivo

Background Implanted medical catheter-related infections are increasing,hence a need for developing catheter polymers bonded to antimicrobials.We evaluated preventive effects of levofloxacin-impregnated catheters in catheterrelated Psuedomonas aeruginosa （strain PAO1） infection.Methods Drug release from levofloxacin-impregnated catheters was measured in vitro.Levofloxacin-impregnated catheters and polyvinyl chloride （PVC） catheters were immersed in 5 ml 50％ Luria Bertani medium containing 108 CFU/ml Pseudomonas aeruginosa then incubated for 6,12,24 or 48 hours at 37℃ when bacteria adhering to the catheters and bacteria in the growth culture medium were determined.Impregnated and PVC catheters were singly implanted subcutaneously in mice,50 μl （107CFU） of PAO1 was injected into catheters.After the first and fifth days challenge,bacterial counts on implanted catheters and in surrounding tissues were determined microbiologically.Bacterial colonization and biofilm formation on implanted catheters were assessed by scanning electron microscopy.Results Drug release from levofloxacin-impregnated catheters was rapid.Levofloxacin-impregnated catheters had significantly fewer bacteria compared to PVC in vitro.After first and fifth day of challenge,no or significantly fewer bacteria adhered to impregnated catheters or in surrounding tissues compared to PVC.Scanning electron microscopical images after first day displayed from none to significantly fewer bacteria adhering to impregnated implanted catheters,compared to bacteria and microcolonies adhering to PVC catheters.After the fifth day,no bacteria were found on impregnated catheters,compared to clusters surrounding mucus-like substance and coral-shaped biofilms with polymorphonuclear leukocyte on PVC catheters.After the first day of challenge,secretion occurred in all implanted catheters with surrounding tissues mildly hyperaemic and swollen.After the fifth day,minute secretions inside impregnated catheters and no inflammation in tissues,whereas purulent secretion inside PVC catheters and abscesses in surrounding tissues.Conclusion Levofloxacin-impregnated catheter is a promising new strategy for prevention of catheter-related Psuedomonas aeruginosa infection.

静脉吸毒致假性动脉瘤伴感染的诊治

目的 探讨静脉吸毒所致假性动脉瘤伴感染的诊断和治疗方法。方法 回顾性分析因静脉吸毒所致假性动脉瘤患者 11例的临床资料。未手术 1例 ;10例行瘤体切除、瘤腔清创及人工血管移植术。结果 死亡 1例。手术 10例术后均无肢体血供障碍 ,3个月后 8例行彩超检查示人工血管通畅。结论 根据吸毒史、搏动性肿物及辅助检查可确诊。彻底清创、血管移植。

猪细环病毒和猪圆环病毒2型混合感染状况的调查

为分析我国猪细环病毒(TTSuV)和猪圆环病毒2型(PCV2)的共感染情况,利用所设计的TTSuV(TTSuV1、TTSuV2)和PCV2特异性引物对我国29个省市采集的猪群血清样品同时进行PCV2和TTSuV(TTSuV1、TTSuV2)PCR检测,分析混合感染情况。结果所检测的1 898份样品中,TTSuV阳性为1 103份(58%),PCV2阳性为435份(23%)。阳性样品中呈混合感染的有275份(14%),其中TTSuV1和PCV2为249份(13%),TTSuV2和PCV2为200份(10%),均为阳性的有174份(9%)。调查结果显示,我国猪群中TTSuV和PCV2混合感染现象较为普遍,对地区性分布特征和饲养模式等影响因素的分析表明TTSuV和PCV2混合感染情况存在地区性差异(P<0.01),但饲养模式并不是共感染的关键因素。

骨痂延长术治疗长骨创伤感染性骨不连接

目的探讨骨痂延长术治疗下肢长骨创伤感染性骨不连接的临床效果。方法采用骨痂延长术治疗下肢长骨创伤感染性骨不连接 94例 ,患者均因内固定、植骨等手术失败。其中 5 9例采用旷置假关节 ,骨节段转移 ;35例采用外露骨切除 ,骨节段转移。结果骨不连接均获治愈 ,肢体短缩同时基本纠正。结论骨痂延长术治疗长骨创伤感染性骨不连接是一种手术创伤小、操作简单、疗程短、疗效可靠的方法。

骨节段转移术治疗长骨创伤感染性骨不连接(附394例报告)

【目的】探讨骨节段转移术治疗下肢长骨创伤感染性骨不连接的临床效果。【方法】采用骨节段转移术治疗下肢长骨创伤感染性骨不连接394例,患者均因内固定、植骨等手术失败。其中259 例采用旷置假关节,骨节段转移;135例采用外露骨切除,骨节段转移。【结果】骨不连接均获治愈,肢体短缩同时基本纠正。【结论】骨节段转移术治疗长骨创伤感染性骨不连接是一种手术创伤小、操作简单、疗程短、疗效可靠的方法。

Ⅰ类切口开颅术后颅内感染的相关危险因素分析

【目的】探讨神经外科Ⅰ类切口开颅术后颅内感染的相关危险因素。【方法】回顾性分析2018年1月至2019年12月于本院接受Ⅰ类切口开颅手术的725例患者的临床资料,对可能的危险因素进行单因素分析及多因素Logistic回归分析。【结果】725例患者术后发生颅内感染63例(8.69%)。单因素分析显示,年龄>50岁、体重指数(BMI)>27kg/m^(2)、手术时间>4h、糖尿病史、急诊手术、术中侧脑室开放、未预防性使用抗生素、留置引流管、脑脊液漏、术中使用显微镜是术后发生颅内感染的相关危险因素(P<0.05)。多因素Logistic回归分析显示,年龄、糖尿病史、未预防性使用抗生素、脑脊液漏、留置引流管是术后发生颅内感染的独立危险因素(P<0.05)。【结论】年龄、糖尿病史、未预防性使用抗生素、留置引流管及脑脊液漏是开颅术后颅内感染的危险因素,临床应采取针对性的预防措施对这些危险因素进行早期干预,降低术后颅内感染率。

脊柱手术术后切口感染病原茵培养及耐药性分析

【目的】分析脊柱手术术后切口感染（postoperativeinfectionofspinaloperation，PISO）的病原茵分布特点及耐药情况，为临床合理用药提供指导。【方法】回顾性分析2002年6月至2012年6月期间脊柱术后切口感染患者的病原茵分布状况及抗菌药物敏感试验结果。【结果】培养出病原茵42株，其中革兰阴性菌（G-）25株，占59．52％，革兰阳性茵（G＋）17株，占40．48％；G-菌中以大肠埃希菌（10／42）、铜绿假单胞茵（7／42）、肺炎克雷伯菌（4／42）、鲍曼不动杆菌（3／42）为主，G＋茵中以金黄色葡萄球菌（9／42）、表皮葡萄球菌（6／42）为主。大肠埃希菌对头孢哌酮／舒巴坦（90．0％）及亚胺培南（100．0％）最敏感。金黄色葡萄球菌对万古霉素最敏感（100．0％）。【结论】G＋菌及G-菌均能在脊柱外科术后切口感染中出现，并以G-菌感染为主，治疗应根据细菌培养及药物敏感试验结果，合理使用抗茵药物。

腰椎间盘手术后椎间隙感染临床分析

【目的】探讨腰椎间盘手术后椎间隙感染的病因、诊断和治疗方法。【方法】回顾分析本院1995年至今978例腰椎间盘手术病人中发生椎间隙感染的16例患者的临床资料。通过对其临床表现,实验室检查及影像学改变进行分析,评价,比较各种治疗方法的疗效。【结果】16例均表现为术后痉挛性腰痛,血沉增快及C-反应蛋白(CRP)增高,5例早期MRI即有特异性改变。16例椎间隙感染的病例采用3种治疗方法:5例保守治疗,7例通过经皮穿刺腰椎间盘切吸术(PLD)进行病灶清除置管冲洗,4例手术治疗,均获痊愈。【结论】根据术后持续性痉挛性腰痛,CRP,血沉及早期MRI改变可对该病作出明确诊断,虽正确的手术与非手术治疗均可治愈本病,但PLD有较多优点,值得推广。

老年宫颈癌患者根治术后感染的病原学特征分析

【目的】分析老年宫颈癌患者根治术后感染的病原学特征。【方法】选取2014年3月至2018年10月在本院接受手术治疗的163例老年宫颈癌患者,分析术后感染发生率、病原学特征及感染危险因素。【结果】术后感染发生率28.22.%(46/163),其中泌尿道感染(43.48%)、手术切口感染(23.91%)和阴道感染(10.87%)排前3位。检出57株病原菌,革兰阴性菌27株(47.39%),革兰阳性菌23株(40.35%),真菌7株(12.28%),检出率排前2位的病原菌分别为大肠埃希菌(21.05%),金黄色葡萄球菌(15.79%)。大肠埃希菌对亚胺培南、利福平和红霉素敏感性高(<10%),对磺胺甲恶唑、哌拉西林、左氧氟沙星和四环素耐药性均在80%以上。金黄色葡萄球菌对亚胺培南敏感性高,耐药率为0,对利福平、青霉素G和左氧氟沙星耐药性均在70%以上,对头孢曲松、四环素和磺胺甲恶唑的耐药性也均在40%以上。单因素和logistics多元回归分析显示:手术时间≥3 h、尿管留置时间≥14 d、抗菌药物使用种类≥3种、术后化疗和贫血是发生术后感染的独立危险因素(P<0.05)。【结论】老年宫颈癌患者根治术后感染发生率较高,主要感染病原菌为大肠埃希菌和金黄色葡萄球菌,且其对临床常见抗菌药物耐药性较高。实际临床工作中应根据耐药性分析结果合理选择抗菌药物,并针对术后感染危险因素采取相关预防措施。

MRI对腰椎间盘突出髓核摘除术后椎间隙感染的早期诊断价值

【目的】探讨MRI技术在早期诊断腰椎间盘突出症患者术后椎间隙感染的临床价值。【方法】回顾性分析2014年1月至2017年1月本院收治的86例腰椎间盘突出症术后发生椎间隙感染患者的临床资料，所有患者行MRI检查，确诊后给予积极治疗，分析其MRI诊断结果，观察比较治疗前后患者的白细胞计数（WBC）、血沉、C反应蛋白（CRP）、白介素-6（IL-6）水平变化。【结果186例椎间隙感染患者检出的病原菌中以金黄色葡萄球茵和大肠埃希茵为主要病原茵。患者的感染部位多数集中在L4／5或L5／S1椎间隙，病变椎间表现为不同程度的椎间盘碎裂、变小、消失、边缘不齐。MRI检查结果显示病变椎间盘间隙失去正常形态和信号，其中长T1低信号77例，T1等信号9例；长Tz高信号82例，短T2低信号4例。病变椎间盘间隙上下的椎体软骨终板以及周围邻近的椎体松质骨均表现有不同程度的损坏，椎体形态上未见有明显变化或出现轻微楔形改变，脊柱未见有后凸表现。术后6个月随访，86例椎间隙感染患者中临床症状完全消失者63例（73．26％），其余23例仍存在轻度间歇性腰痛。所有患者治疗后WBC、血沉以及CRP、IL-6水平均显著低于治疗前，差异具有统计学意义（P〈0．05）。【结论IMRI可清晰显示腰椎间盘突出症髓核摘除术后发生椎间隙感染的患者的病变感染部位，对于椎间隙感染的早期诊断鉴别及治疗具有重要意义。

腰椎间盘术后早期深部感染的临床处理与疗效评价

【目的】探讨腰椎间盘术后早期深部感染的临床处理方法，评价其疗效。【方法】回顾分析湖南省人民医院骨科2006年5月至2014年5月腰椎间盘术后早期深部感染确诊病例，共17例。实施手术13例，行前路和（或）后路病灶清除＋置管灌洗术；非手术4例，根据细菌培养及药敏试验使用抗生素（＞4～6周）并卧床。达到感染治愈标准后的1～2周，佩戴外固定支具下床活动。【结果】13例手术治疗者术后24～48 h腰痛VAS评分由术前（8．7±2．1）分改善至术后（3．2±1．3）分，平均抗生素使用时间（35±2） d ，2例患者因减张缝合术后4周拆线，其余均12～16 d一期拆线，切口愈合良好；4例非手术者治疗约4周后症状明显改善，平均抗生素使用时间（28±1）d，腰痛VAS评分由治疗前（7．9±2．2）分改善至治疗后（2．3±1．4）分。所有病例实验室复查白细胞、CRP正常和（或）ESR基本恢复正常，MRI复查信号均正常或有明显改善后予以出院，住院时间平均（74±2．5） d。随访6～60个月，均无感染复发情况，常规复查X线和（或）C T提示骨性融合，脊柱稳定性恢复，MRI提示信号正常或明显改善，达到临床愈合。【结论】腰椎间盘术后早期深部感染确诊后以有效抗生素治疗（＞4～6周）和卧床为主，若短期内药物治疗无效，体温和白细胞持续升高、C-反应蛋白（CRP）与血沉（ESR）持续不降或升高，或者影像学显示软组织或终板有破坏信号改变者应及时手术治疗，能迅速缓解疼痛、缩短病程，获得临床愈合。

禽流感病毒鸭源分离株的动物感染试验

选择两株新近分离的具有脑坏死病变特征的番鸭源禽流感病毒(AIV)毒株和两株前期分离的无脑坏死病变的AIV毒株,进行不同动物的感染试验,以期获得病毒在不同动物的致病病变特征和不同动物的易感性比较。结果表明,番鸭源AIV毒株较其他两毒株致病力强,且四毒株对鸡、鹅的致病力比对不同品种的鸭强。

关节外科工类切口手术感染调查及干预评价

【目的】探讨本院关节外科Ⅰ类切口手术感染的高危因素及降低感染率的干预措施。【方法】回顾性调查2013年本院关节外科Ⅰ类切口手术患者489例，分析术后感染病例的高危因素；针对高危因素设计干预方案并进行效果评估。【结果】本院关节外科Ⅰ类切口手术感染率为10．02％；高龄是术后感染最大的高危因素；不同手术类别及不同医生组间的感染率稍有差异；优化围术期预防用抗菌药物给药方案后有助于降低手术后感染风险。【结论】应加强关节外科围术期的全方位监测工作；针对有感染高危因素的患者可优化预防用抗菌药物方案从而降低术后感染风险。