Background: The coronavirus disease 2019 (COVID-19) has forced accelerated optimization of Emergency Department (ED) process, and simulation tools offer an alternative approach to strategic assessment and selection.Methods: Field research and case analysis methods were used to obtain the treatment process and medical records information from the ED of a general hospital. Minitab was used for analysis of the measurement system, and Arena was applied for simulation modelling. We established a framework for the triage protocol of ordinary and quarantined patients, analysed bottlenecks in the treatment time of the hospital's ED, and proposed an optimised management strategy.Results: The computed tomography (CT) pre-scheduling strategy simulation results demonstrated that longer CT room preparation times for quarantined people before their arrival (T p ) resulted in reduced CT scan and waiting times for quarantined patients, but these times were longer for ordinary patients.The nucleic acid priority strategy simulation results demonstrated that when the average daily number of ordinary patients (λ c ) was relatively stable, the hospital could guide ordinary patients to perform nucleic acid testing first followed by CT testing. However, when λ c fluctuated greatly, the hospital could appropriately reduce the proportion of preferential nucleic acid testing. Furthermore, when λ c was overloaded, the nucleic acid priority strategy showed no advantages. The joint analysis results demonstrated that the optimal strategy selection was significantly affected by the severity of the epidemic. The nucleic acid detection sample size optimisation strategy demonstrated that optimizing the sample size of each batch according to the number of patients could effectively reduce the waiting times for nucleic acid testing (T n ).Conclusions: Simulation tools are an alternative method for strategic evaluation and selection that do not require external factors.

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Background Bloodstream infections (BSIs) are always associated with increased cost, prolonged hospitalization and higher mortality, especially for patients in intensive care units (ICUs). Klebsiella pneumoniae is recognized as the major cause of bacteremia around the world and resistant to most clinically significant antibiotics. This retrospective study focused on drug susceptibility and molecular epidemiology of K. pneumoniae isolated from ICU patients with BSI in Shanghai, China.Methods Consecutive K. pneumoniae isolates were collected from ICU patients with bacteremia in Shanghai from January 2016 to December 2019. Antibiotic susceptibility testing and primary screening test for extended-spectrum β-lactamase (ESBL) and carbapenemase production were conducted by broth microdilution method. Polymerase chain reaction (PCR) was performed to detect antimicrobial resistance genes and to confirm carbapenemase production. We also conducted multilocus sequence typing (MLST), of which the result was analyzed by GoeBURST.Results A total of 78 K. pneumoniae isolates were enrolled. K. pneumoniae isolated from ICU bloodstream infections (ICU-BSIs) were highly resistant to almost all clinically common antibiotics, except for colistin (11.5%) and tigecycline (23.0%). ESBL-producing and carbapenemase-producing K. pneumoniae accounted for 74.4% and 71.7%, respectively. The most frequently found genotype in ESBL producers was blaCTX−M−14 (44/58, 75.9%), followed by blaCTX−M−15 (15/58, 25.9%) and blaCTX−M−55 (8/58, 13.8%). KPC is the only enzyme generated by carbapenemase producers and all KPC enzymes were encoded by blaKPC−2. The most principal ST was ST11 (50/78, 64.1%), followed by ST15 (7/78, 9.0%) and ST23 (3/78, 3.8%). Two newfound sequence types were identified in our study.Conclusions This study is the first to demonstrate the antibiotic resistance phenotype and molecular epidemiology of K. pneumoniae isolated from ICU patients with bloodstream infections in Shanghai. It is noteworthy that ICU-BSI K. pneumoniae is characteristic of high resistance rate. According to the consequence of resistance gene detection and MLST analysis, the prevalence of KPC-2 enzyme may result from nosocomial clonal dissemination of ST11 K. pneumoniae.

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