目的 了解中国医院临床微生物室参与医院感染及抗菌药物使用管理的现状.方法 抽取中国7大地区14个省(市)、自治区及部队所属的医院,对2000年以前、及以后每5年为一时间段至2015年的临床微生物室参与医院感染性疾病的会诊,标本质量控制,抗菌药物使用及多重耐药菌管理等方面开展调查,并对调查结果进行统计分析.结果 共抽取调查医院187所,2015年其临床微生物室参与感染性疾病会诊以及多重耐药菌多部门协作管理工作的医院分别有96、172所(占51.34％、、91.98％),但仍有23.53％(44所)医院临床微生物室使用手工统计分析药敏结果,具备病原菌同源性鉴定能力者仅26所(13.90％).2010年与2015年相比,MDRO监测数据反馈临床的比率由66.84％(125所)上升至95.72％(179所),反馈频率以每月和每季度为主;开展向临床反馈药敏结果的比率从62.03％(116所)上升至94.12％(176所),82.35％(154所)临床微生物室实现按季度反馈;开展痰培养前痰涂片镜检质量控制的比率由63.10％(118所)上升至87.17％(163所);血培养推行双侧双份的比率由35.83％(67所)提升至72.73％(136所);其他无菌体液(除血、尿以外)标本的比率由4.86％上升至5.74％;2010年与2015年各组比较,差异均有统计学意义(均P＜0.05).结论 中国医院临床微生物室在医院感染防控方面取得了较大进展,特别是2011—2015年间,但在医院感染病原菌同源性分析、结果反馈信息化推进和无菌体液标本的送检方面有待进一步加强.%Objective To investigate current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use.Methods Fourteen provinces (municipalities), autonomous regions and army hospitals in seven regions of China were selected, the participation of clinical microbiological laboratories in the consultation of HAI diseases, specimen quality control, antimicrobial use, and management of multidrug-resistant organisms (MDROs) before 2000 and every five years from 2000 to 2015 were investigated, the surveyed results were analyzed statistically.Results A total of 187 hospitals were investigated, in 2015, 96 and 172 hospitals (51.34％, 91.98％) participated in the consultation of infectious diseases and multi-department collaborative management on MDROs respectively.However, 44 hospitals (23.53％) still manually performed statistical analysis on drug susceptibility, only 26 hospitals (13.90％) had the ability of identifying homology of pathogens.Rate of MDRO surveillance data feedbacked to clinical departments increased from 66.84％ (n=125) in 2010 to 95.72％ (n=179) in 2015, the frequency of feedback was mainly monthly and quarterly;rate of antimicrobial susceptibility results feedbacked to clinic departments increased from 62.03％ (n=116) to 94.12％ (n=176), 82.35％ (n=154) of clinical microbiological laboratories conducted quarterly feedback;the quality control rate of microscopic sputum smear before sputum culture increased from63.10％ (n=118) to 87.17％ (n=163);rate of bilateral double blood culture increased from 35.83％ (n=67) to 72.73％ (n=136);rates of other aseptic body fluid culture (except blood and urine) increased from 4.86％ to 5.74％;differences were all significantly different between 2010 and 2015 (all P＜0.05).Conclusion Clinical microbiological laboratories have played an important role in promoting the development of HAI management in China, especially during the period of 2011-2015.However, the homology analysis on HAI pathogens, informatization of result feedback, and sterile body fluid specimens detection need to be further strengthened.
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