Urinary tract infection (UTI) is traditionally classified as community-acquired (CA) and hospital-acquired (HA). Community-onset health care-associated (HCA) infection is a new category that has gained increasing attention. The study aimed to compare the disk susceptibility of nonrepetitive Escherichia coli urinary isolates from HCA-UTI (n = 100) with that of E. coli isolates from CA-UTI (n = 85) and HA-UTI (n = 106). We found that the susceptibility pattern of HCA-UTI E. coli isolates was similar to that of HA-UTI E. coli isolates, but significantly different from that of CA-UTI E. coli isolates. In particular, the proportion of extended-spectrum β-lactamase-producing isolates was significantly higher in HCA-UTI than that in CA-UTI (30.0% vs. 3.5%, p < 0.001). We recommend that when treating HCA-UTI, it is necessary to take urine cultures for susceptibility testing to guide definite antibiotic therapy.

Enterobacter cloacae is one of the most common carbapenem-resistant Enterobacteriaceae (CRE) global wide. Resistance to tigecycline, one of the few therapeutic options for CRE infections, in carbapenem-resistant E. cloacae is of clinical significance. Fourteen E. cloacae clinical isolates (EC1-EC14) co-resistant to tigecycline and carbapenems were studied. Two tigecycline-susceptible/carbapenem-resistant isolates (TS1-TS2) were used for comparison. Genotyping by pulsed-field gel electrophoresis and multilocus sequence typing identified seven pulsotypes and three sequence types (STs). All three STs belonged to the published international clones. Polymerase chain reaction (PCR) and sequence analysis revealed the coexistence of bla and bla in 11 EC isolates from five pulsotypes/two STs. Reverse transcription PCR demonstrated overexpression of the chromosomal AmpC-like β-lactamase in seven EC isolates (four pulsotypes/two STs) and TS1 (pulsotype F/ST78). Reduced expression of outer membrane protein C (OmpC) was found in three EC isolates (all pulsotype C/ST204), whereas reduced expression of OmpF was found in nine EC isolates (three pulsotypes/two STs) and TS2 (pulsotype G/ST114). Overexpression of the efflux pump AcrB was found in all EC isolates although three showed borderline significance. Multiple mechanisms jointly contributed to the observed co-resistance to tigecycline and carbapenems. Some international clones have infiltrated into Taiwan and acquired various resistance traits independently.

Objective: To assess the application effect of Healthcare integration in perioperative period management of aged Hip arthroplasty. Methods: 30 patients were randomly selected from 60 patients to implement Heathcare integration management model(the experimental group), tranditional care service mode was given to the other 30 patients(the control group). On the 14th day after operation, patients'satisfaction degree, health education awareness and clinical nursing compliance were compared. Results: Compared with the control group, the patients' satisfaction degree, health education awareness rate, clinical nursing compliance of the experimental group were improved. Conclusions: Compared with ordinary care model, heathcare integration model can improve the patients' satisfaction and awareness rate, smooth the clinical nursing process, alleviate the pain of patients, and improve the quality of patients' life. So it is adviced that heathcare integration model be widely applied in perioperative period management of aged Hip arthroplasty.