After more than 30 years of localized development of infection prevention and control in China, a prevention and control system in line with China’s conditions has been established. Since the coronavirus disease 2019 pandemic began, with the unprecedented attention paid to healthcare associated infection by health administrative departments at all levels, the awareness of infection prevention and control of various personnel has been continuously strengthened, which has promoted the cross-integration and development of infection prevention and control-related disciplines. However, under the normalized pandemic prevention and control, infection prevention and control work also faces enormous pressure and challenges. This paper summarizes the opportunities for infection prevention and control in the new era, analyzes the current challenges in the field of infection prevention and control, and aims to provide some ideas for the future development of infection prevention and control.
In October 2022, thirteen government departments including the National Health Commission jointly issued the National Action Plan to Combat Antimicrobial Resistance (2022-2025) to proactively address challenges of antimicrobial resistance. In support of the implementation of the National Action Plan in healthcare institutions, the authors put forward following suggestions for prevention and control measures: strengthen construction of supporting systems and disciplines, enhance prevention and control of hospital-acquired infections caused by drug-resistant bacteria, promote precision diagnosis and treatment through diagnostic stewardship, advance rational drug use by performing prescription review, carry out universal and targeted training, establish clinical decision support systems using information technology, improve monitoring and evaluation systems, and enhance multi-source data fusion and application.
There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Healthcare-associated infection management has advanced rapidly in recent years. With the development of more standards and guidelines, infection control measures become more standardized and evidence-based. Evidence-based measures are increasingly applied in infection control, which promote more studies on the prevention and control of healthcare-associated infections. Furthermore, more new ideas of infection control have emerged, with old ones being challenged. The hand hygiene reform, multidrug-resistant organisms, and surgical site infections become the hot topics in recent years. In addition, whole-genome sequencing also provides more bases for understanding pathogen transmission in hospitals. Based on the high-quality studies published in recent years, this opinion review discusses these hot topics in the prevention and control of healthcare-associated infections.
目的 探讨肾移植患者非结核分枝杆菌（NTM）病临床特点及分子诊断。 方法 回顾性分析2011年4月1例皮肤软组织NTM感染的肾移植患者的临床特点，并以其病变组织DNA为模板，聚合酶链反应（PCR）扩增hsp65基因和rpoB基因序列，测序比对鉴定其NTM菌种。结合文献复习NTM病及分析分子生物学技术在移植患者NTM感染诊断中的作用。 结果 该肾移植患者系皮肤软组织胞内分枝杆菌感染，临床特点与结核病极其相似，难以进行鉴别诊断。PCR扩增、测序的结果显示hsp65产物和rpoB产物序列与胞内分枝杆菌GeneBank中FJ643456.1及CP003324.1序列100%一致。 结论 NTM病的临床表现与结核病相似，分子生物学方法鉴定菌种对移植患者胞内分枝杆菌病的诊断有帮助。