三水区某综合医院多重耐药菌感染调查研究
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摘要
目的:研究与分析三水区某综合医院多重耐药菌(MDRO)感染现状,以便为临床感染防控提供依据。方法:选取2016年10月-2018年9月三水区某综合医院住院患者的资料进行回顾性分析,记录MDRO构成比及检出率、MDRO科室分布及构成比等,同时按是否进行MDRO分析和采取针对性防控措施将2016年第4季度至2017年第3季度(2016年10月-2017年9月,n=42 297)作为对照组、2017年第4季度至2018年第3季度(2017年10月-2018年9月,n=42 222)作为观察组,对比两组医院感染、社区感染构成比、MDRO感染率。结果:本次共计检出MDRO感染526例,包括MRSA(94例)、ESBLS大肠埃希菌(274例)、ESBLS肺炎克雷伯菌(69例)、CRABA(66例)、CRPAE(14例)、CER(9例),从标本来源来看尿标本最多,其次为痰标本、血标本、分泌物标本,男性与女性比例相当(270︰256),年龄上10～60岁与≥60岁较多;多耐医院感染例数223例,占42.40%;社区感染303例,占57.60%。检出率按季度分布来看,ESBLS大肠埃希菌总体呈现下降趋势,而其余三者在观察组期间有所升高;ESBLS大肠埃希菌在第4季度最高,CRABA在第4季度明显低于其他季度。发生医院感染的前五个科室依次是ICU、神经外科、康复医学科、创伤骨科、泌尿外科;发生社区感染的前五位依次是感染内科、泌尿外科、ICU、呼吸内科、内分泌科。两组医院感染构成比、社区感染构成比、MDRO医院感染率对比,观察组MDRO医院感染构成比和MDRO医院感染率均明显低于对照组(P<0.05),观察组多重耐药社区感染构成比明显高于对照组(P<0.05)。结论:三水区某综合医院多重耐药菌感染以社区感染为主,监测菌株以ESBLS大肠埃希菌最为常见,尿标本中检出最多,且存在季节分布差异,若能尽早分析MDRO感染情况,积极制定有效的措施进行防控,对减少MDRO感染发生有着积极的意义,值得重视。
Objective:To study and analyze the infection status of multi-drug resistant bacteria(MDRO in a third-class A hospital in Sanshui District,so as to provide evidence for clinical infection prevention and control.Method:A retrospective analysis was conducted on inpatients from October 2016 to September 2018 in a third-class A hospital in Sanshui district.MDRO constituent ratio and detection ratio,MDRO Department distribution and constituent ratio,MDRO susceptibility factors and MDRO nosocomial infection case composition were recorded.According to whether or not MDRO analysis and prevention and control were carried out,the patients were divided into two groups,from the fourth quarter of 2016 to the third quarter of 2017(October 2016 to September 2017,n=42 297),no MDRO prevention and control was carried out as the control group.From the fourth quarter of 2017 to the third quarter of 2018(October 2017 to September 2018,n=42 222),MDRO analysis and prevention and control were carried out as the observation group.The hospital infection,community infection ratio,MDRO infection rate were compared between two groups.Result:526 cases of MDRO infection were detected,including MRSA(94 cases),ESBLS Escherichia coli(274 cases),ESBLS Klebsiella pneumoniae(69 cases),CRABA(66 cases),CRPAE(14 cases)and CER(9 cases).From the source of samples,urine samples were the most,followed by sputum samples,blood samples,secretion samples,most of them were aged10-60 years or over 60 years,the sex ratio of male and female was similar(270︰256).223 cases(42.40%)suffered from multi-resistant nosocomial infections and 303 cases(57.60%)from community infections.According to the quarterly distribution of common MRSA,ESBLS Escherichia coli,CRABA,CRPAE detection rates,ESBLS Escherichia coli overall showed a downward trend,while the remaining three increased during the observation group.From the MDRO Department distribution results,ICU was the most,followed by urology,infectious medicine,respiratory medicine,rehabilitation medicine.The hospital infection and MDRO infection of the observation group were significantly lower than those of the control group(P<0.05),the community infection of the observation group was higher than that of the control group(P<0.05).Conclusion:There are many multi-drug-resistant bacteria infections in a third-class A hospital in Sanshui District.Escherichia coli ESBLS is the most common pathogen,and most of them are detected in urine samples.There are seasonal distribution differences.If MDRO infection can be analyzed as soon as possible and effective measures can be formulated to prevent and control MDRO infection,it is of positive significance to reduce the incidence of MDRO infection,and should pay attention to it.
Objective:To study and analyze the infection status of multi-drug resistant bacteria(MDRO in a third-class A hospital in Sanshui District,so as to provide evidence for clinical infection prevention and control.Method:A retrospective analysis was conducted on inpatients from October 2016 to September 2018 in a third-class A hospital in Sanshui district.MDRO constituent ratio and detection ratio,MDRO Department distribution and constituent ratio,MDRO susceptibility factors and MDRO nosocomial infection case composition were recorded.According to whether or not MDRO analysis and prevention and control were carried out,the patients were divided into two groups,from the fourth quarter of 2016 to the third quarter of 2017(October 2016 to September 2017,n=42 297),no MDRO prevention and control was carried out as the control group.From the fourth quarter of 2017 to the third quarter of 2018(October 2017 to September 2018,n=42 222),MDRO analysis and prevention and control were carried out as the observation group.The hospital infection,community infection ratio,MDRO infection rate were compared between two groups.Result:526 cases of MDRO infection were detected,including MRSA(94 cases),ESBLS Escherichia coli(274 cases),ESBLS Klebsiella pneumoniae(69 cases),CRABA(66 cases),CRPAE(14 cases)and CER(9 cases).From the source of samples,urine samples were the most,followed by sputum samples,blood samples,secretion samples,most of them were aged10-60 years or over 60 years,the sex ratio of male and female was similar(270︰256).223 cases(42.40%)suffered from multi-resistant nosocomial infections and 303 cases(57.60%)from community infections.According to the quarterly distribution of common MRSA,ESBLS Escherichia coli,CRABA,CRPAE detection rates,ESBLS Escherichia coli overall showed a downward trend,while the remaining three increased during the observation group.From the MDRO Department distribution results,ICU was the most,followed by urology,infectious medicine,respiratory medicine,rehabilitation medicine.The hospital infection and MDRO infection of the observation group were significantly lower than those of the control group(P<0.05),the community infection of the observation group was higher than that of the control group(P<0.05).Conclusion:There are many multi-drug-resistant bacteria infections in a third-class A hospital in Sanshui District.Escherichia coli ESBLS is the most common pathogen,and most of them are detected in urine samples.There are seasonal distribution differences.If MDRO infection can be analyzed as soon as possible and effective measures can be formulated to prevent and control MDRO infection,it is of positive significance to reduce the incidence of MDRO infection,and should pay attention to it.
引文
[1]张建娜,陈晓莉,叶磊.急诊ICU多重耐药菌医院感染控制的综合干预效果评价[J].护理管理杂志,2017,17(12):926-928.
[2]孙光,徐超,王春芳,等.某院普通外科多重耐药菌感染综合干预效果[J].中国感染控制杂志,2017,16(6):555-557.
[3]连丽,孙红鑫.综合干预措施对多重耐药菌医院感染防控效果的分析[J].中国冶金工业医学杂志,2017,34(3):304-305.
[4]李颖,许文,戈伟,等.提高多重耐药菌防控措施执行力对降低多重耐药菌医院感染的影响[J].中国感染控制杂志,2017,16(2):126-129.
[5]陈亚男,刘菁,田丽梅,等.ICU多重耐药菌目标性监测与干预效果分析[J].中国感染控制杂志,2017,16(1):58-61,65.
[6]刘仕莲,王燮辞,赵思阳.综合干预对ICU患者多重耐药菌感染的防控效果[J].预防医学情报杂志,2016,32(11):1230-1233.
[7]许新玲,王春香,梁华,等.某综合医院住院患者感染多重耐药菌的监测与干预措施[J].中国消毒学杂志,2016,33(9):871-873.
[8]周静,陶丽,张立萍,等.连续4年多重耐药菌医院感染监测及干预效果评价[J].中国消毒学杂志,2016,33(4):364-366.
[9]梅雪飞,荚恒敏,张亮,等.综合干预措施对ICU患者呼吸道多重耐药菌感染/定植的防控效果[J].中国感染控制杂志,2016,15(3):176-178.
[10]雷曦兵,陈丽萍,肖亚雄,等.某三级甲等医院实施多重耐药防控干预效果研究[J].华西医学,2016,31(3):409-413.
[11]刘帆,刘逸文,郑勇,等.神经科重症监护病房医院感染多重耐药菌及综合干预效果[J].中国感染控制杂志,2016,15(2):117-119.
[12]于爱玲.综合干预措施对医院多重耐药菌感染的防控作用[J].山东医药,2016,56(5):104-105.
[13]吴淑梅,黄小兰,任泽娟.集束化管理策略在多重耐药菌管理中的应用[J].中国感染控制杂志,2015,14(12):840-842,845.
[14]宋洲洋,齐秀英.某综合医院多重耐药菌监测及干预效果分析[J].现代预防医学,2015,42(24):4497-4499,4504.
[15]刘彩红,李福琴,刘盛楠,等.综合干预措施可降低重症监护病房多重耐药菌医院感染发病率[J].中国感染控制杂志,2015,14(8):553-556.
[16]刘玉岭,史广鸿,田真.某综合医院多重耐药菌感染目标性监测与综合干预研究[J].中国感染控制杂志,2015,14(6):383-385,398.
[17]刘璐璐,牟作峰,杨会香,等.重症监护病房多重耐药菌感染的现状及综合干预对策[J].护理研究,2015,29(2):144-147.
[18]李辉,孙晓辉,欧柳红.综合ICU多重耐药菌感染的监测及综合干预研究[J].中国感染控制杂志,2013,12(3):196-198.
[19]周健,孟军,江淑芳.综合ICU多重耐药菌感染的分析与护理干预[J].护士进修杂志,2012,27(19):1743-1744.
[20]钟爱玉,戴鋆,方咏梅.综合干预措施降低多重耐药菌感染研究[J].中国感染控制杂志,2012,11(4):287-289,292.
[2]孙光,徐超,王春芳,等.某院普通外科多重耐药菌感染综合干预效果[J].中国感染控制杂志,2017,16(6):555-557.
[3]连丽,孙红鑫.综合干预措施对多重耐药菌医院感染防控效果的分析[J].中国冶金工业医学杂志,2017,34(3):304-305.
[4]李颖,许文,戈伟,等.提高多重耐药菌防控措施执行力对降低多重耐药菌医院感染的影响[J].中国感染控制杂志,2017,16(2):126-129.
[5]陈亚男,刘菁,田丽梅,等.ICU多重耐药菌目标性监测与干预效果分析[J].中国感染控制杂志,2017,16(1):58-61,65.
[6]刘仕莲,王燮辞,赵思阳.综合干预对ICU患者多重耐药菌感染的防控效果[J].预防医学情报杂志,2016,32(11):1230-1233.
[7]许新玲,王春香,梁华,等.某综合医院住院患者感染多重耐药菌的监测与干预措施[J].中国消毒学杂志,2016,33(9):871-873.
[8]周静,陶丽,张立萍,等.连续4年多重耐药菌医院感染监测及干预效果评价[J].中国消毒学杂志,2016,33(4):364-366.
[9]梅雪飞,荚恒敏,张亮,等.综合干预措施对ICU患者呼吸道多重耐药菌感染/定植的防控效果[J].中国感染控制杂志,2016,15(3):176-178.
[10]雷曦兵,陈丽萍,肖亚雄,等.某三级甲等医院实施多重耐药防控干预效果研究[J].华西医学,2016,31(3):409-413.
[11]刘帆,刘逸文,郑勇,等.神经科重症监护病房医院感染多重耐药菌及综合干预效果[J].中国感染控制杂志,2016,15(2):117-119.
[12]于爱玲.综合干预措施对医院多重耐药菌感染的防控作用[J].山东医药,2016,56(5):104-105.
[13]吴淑梅,黄小兰,任泽娟.集束化管理策略在多重耐药菌管理中的应用[J].中国感染控制杂志,2015,14(12):840-842,845.
[14]宋洲洋,齐秀英.某综合医院多重耐药菌监测及干预效果分析[J].现代预防医学,2015,42(24):4497-4499,4504.
[15]刘彩红,李福琴,刘盛楠,等.综合干预措施可降低重症监护病房多重耐药菌医院感染发病率[J].中国感染控制杂志,2015,14(8):553-556.
[16]刘玉岭,史广鸿,田真.某综合医院多重耐药菌感染目标性监测与综合干预研究[J].中国感染控制杂志,2015,14(6):383-385,398.
[17]刘璐璐,牟作峰,杨会香,等.重症监护病房多重耐药菌感染的现状及综合干预对策[J].护理研究,2015,29(2):144-147.
[18]李辉,孙晓辉,欧柳红.综合ICU多重耐药菌感染的监测及综合干预研究[J].中国感染控制杂志,2013,12(3):196-198.
[19]周健,孟军,江淑芳.综合ICU多重耐药菌感染的分析与护理干预[J].护士进修杂志,2012,27(19):1743-1744.
[20]钟爱玉,戴鋆,方咏梅.综合干预措施降低多重耐药菌感染研究[J].中国感染控制杂志,2012,11(4):287-289,292.