住院患者医院内感染调查分析

摘要

Object To analyse the incidence,infection characteristics and influencing factors of nosocomial infection for 28574 inpatients in upper second-class hospital in 2017. Methods 28574 patients hospitalized from January to December 2017 were monitored by the nosocomial infection real-time monitoring system. And then the infection site and pathogen distribution were analyzed. Results The top three departments of nosocomial infection rate were intensive care unit(ICU)(17.27%),department of rehabilitation(2.61%)and department of neurosurgery(1.74%). The nosocomial infection sites were:110 patients infected in lower respiratory tract(45.45%),53 patients in urinary tract(21.90%),30 patients in upper respiratory tract(12.40%). The rate of pathogen submitting for detection for antimicrobial users was 79.31%. A total of 3384 strains were detected,and pathogenic detection rate was 35.25%. Gram-negative(G-)bacteria accounted for 68.56%,Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae were the main pathogens. And Gram-positive(G+)bacteria accounted for 23.17%,Staphylococcus aureus was the main pathogen. Pseudomonas aeruginosa had higher resistance rate to cephalosporins and lower resistance rate to quinolones and aminoglycosides,Escherichia coli developed certain drug resistance to cephalosporins and quinolones,Staphylococcus aureus had higher resistance rate to penicillin,erythromycin and clindamycin. Conclusions The rate of nosocomial infection is low in this hospital,the rate of pathogen submitting for detection for antimicrobial users is not high,the pathogenic bacteria are mainly G- bacteria. The common nosocomial infection pathogenic bacteria have higher resistance rate to cephalosporins and lower resistance rate to quinolones and aminoglycosides. It is an effective measures for controlling nosocomial infection in grass-roots hospitals,by strengthening the prevention and control management of nosocomial infection,improving the awareness of medical staff in controlling nosocomial infection,improving the rate of pathogen submitting detection,and improving rationally usage of antibacterial agents according to the results of drug sensitivity.%目的 分析某二甲医院28574例住院患者医院内感染发病情况、感染特点及影响因素.方法 通过医院内感染实时监控系统监测2017年1月至12月住院患者28574例,分析感染部位、病原菌分布情况.结果 28574例住院患者发生医院内感染217例(242例次),感染率0.76%,例次感染率0.85%.医院内感染率前3位的科室是重症医学科(17.27%)、康复科(2.61%)和神经外科(1.74%).医院内感染部位依次是:下呼吸道110例(45.45%)、泌尿道53例(21.90%)、上呼吸道30例(12.40%).抗菌药物使用者病原学送检率为79.31%,共检出菌株3384株,病原菌检出率为35.25%.病原菌G-菌占68.56%,其中铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主,G+菌占23.17%,以金黄色葡萄球菌为主.铜绿假单胞菌对头孢霉素类药物耐药率较高,对喹诺酮类、氨基糖苷类药物耐药率较低;大肠埃希菌对头孢霉素类、喹诺酮类产生一定的耐药性,金黄色葡萄球菌对青霉素、红霉素、克林霉素较高的耐药率.结论 该院医院内感染率较低,抗菌药物使用者病原学送检率不高,病原菌以G-菌为主,常见医院内感染病原菌对头孢霉素类药物耐药率较高,对喹诺酮类、氨基糖苷类药物耐药率较低.加强医院内感染的预防控制管理,提高医务人员对控制医院内感染的认识,提高病原学送检率,根据药敏结果合理使用抗菌药物是基层医院控制感染的有效措施.