天津东部医疗中心2017年医院感染发生特点及耐药性分析
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摘要
目的分析933例医院感染患者的感染部位、病原菌分布、耐药性及临床科室例次感染率,为医院感染的预防控制与治疗提供临床依据。方法选取2017年1月-2017年12月天津东部医疗中心933例医院感染患者为研究对象,对感染部位、病原菌分布、耐药性及临床科室例次感染率进行分析。结果 933例医院感染患者中下呼吸道感染所占比例最高297例(31.83%),医院感染高发科室为综合ICU,例次感染率为14.26%,高于内科系统、外科系统,差异有统计学意义(P<0.001)。医院感染患者的送检标本中共检出病原菌622株,其中革兰阴性菌447株,占71.87%;革兰阳性菌141株,占22.67%;真菌31株,占4.98%。革兰阴性菌中的肺炎克雷伯菌、大肠埃希菌对氨苄西林的耐药率最高;铜绿假单胞菌对替卡西林耐药率最高;鲍氏不动杆菌对多数抗菌药物普遍耐药。革兰阳性菌中的屎肠球菌和金黄色葡萄球菌对氨苄西林、红霉素的耐药率很高。结论医院感染患者感染部位以下呼吸道为主,ICU为高发科室,其病原菌分布及其耐药性均有其自身特点,应以此做为临床依据,加强防控、指导治疗。
OBJECTIVE To investigate the infection sites of 933 patients with nosocomial infection,distribution of pathogens,drug resistance and case-time infection rates in clinical departments so as to provide guidance for clinical prevention and treatment of nosocomial infection.METHODS A total of 933 patients with nosocomial infection who were treated in Eastern Medical Center of Tianjin from Jan 2017 to Dec 2017 were recruited as the study objects.The infection sites,distribution of pathogens,drug resistance rates and case-time infection rates in clinical departments were observed.RESULTS Of the 933 patients with nosocomial infection,297(31.83%)had lower respiratory tract infection;the case-time infection rate of the general ICU was 14.26%,significantly higher than that of the internal medicine department and surgical departments(P<0.001).Totally 622 strains of pathogens were isolated from the submitted specimens of the patients with nosocomial infection,447(71.87%)of which were gram-negative bacteria,141(22.67%)were gram-positive bacteria,and 31(4.98%)were fungi.Among the gram-negative bacteria,the drug resistance rate of Klebsiella pneumoniae and Escherichia coli strains to ampicillin was the highest,the drug resistance rate of Pseudomonas aeruginosa strains to ticarcillin was the highest,and Acinetobacter baumannii strains were resistant to most of the antibiotics.Among the gram-positive bacteria,Enterococcus faecium and Staphylococcus aureus strains were highly resistant to ampicillin and erythromycin.CONCLUSION The patients with lower respiratory tract infection are dominant among the patients with nosocomial infection,the infection is highly prevalent in the ICU,the distribution and drug resistance of the pathogens have its own characteristics,therefore,it is necessary to strengthen the prevention and guide the treatment based on the distribution and drug resistance of the pathogens.
OBJECTIVE To investigate the infection sites of 933 patients with nosocomial infection,distribution of pathogens,drug resistance and case-time infection rates in clinical departments so as to provide guidance for clinical prevention and treatment of nosocomial infection.METHODS A total of 933 patients with nosocomial infection who were treated in Eastern Medical Center of Tianjin from Jan 2017 to Dec 2017 were recruited as the study objects.The infection sites,distribution of pathogens,drug resistance rates and case-time infection rates in clinical departments were observed.RESULTS Of the 933 patients with nosocomial infection,297(31.83%)had lower respiratory tract infection;the case-time infection rate of the general ICU was 14.26%,significantly higher than that of the internal medicine department and surgical departments(P<0.001).Totally 622 strains of pathogens were isolated from the submitted specimens of the patients with nosocomial infection,447(71.87%)of which were gram-negative bacteria,141(22.67%)were gram-positive bacteria,and 31(4.98%)were fungi.Among the gram-negative bacteria,the drug resistance rate of Klebsiella pneumoniae and Escherichia coli strains to ampicillin was the highest,the drug resistance rate of Pseudomonas aeruginosa strains to ticarcillin was the highest,and Acinetobacter baumannii strains were resistant to most of the antibiotics.Among the gram-positive bacteria,Enterococcus faecium and Staphylococcus aureus strains were highly resistant to ampicillin and erythromycin.CONCLUSION The patients with lower respiratory tract infection are dominant among the patients with nosocomial infection,the infection is highly prevalent in the ICU,the distribution and drug resistance of the pathogens have its own characteristics,therefore,it is necessary to strengthen the prevention and guide the treatment based on the distribution and drug resistance of the pathogens.
引文
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[9]吴安华,文细华,李春辉,等.2012年全国医院感染现患率与横断面抗菌药物使用率调查报告[J].中国感染控制杂志,2014,13(1):8-15.
[10]Kamalbeik S,Talaie H,Mahdavinejad A,et al.Multidrugresistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction:is there an association?[J].Korean J Anesthesiol,2014,66(4):295-299.
[11]Rosenthal VD,Al-Abdely HM,EI-Kholy AA,et al.International Nosocomial Infection Control Consortium report,data summary of 50 countries for 2010-2015:device-associated module[J].Am J Infect Control,2016,44(12):1495-1504.
[12]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[13]Goodman KE,Simner PJ,Tamma PD,et al.Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae(CRE)[J].Expert Rev Anti Infect Ther,2016,14(1):95-108.
[14]张小江,杨启文,王瑶,等.2016年北京协和医院细菌耐药性监测[J].协和医学杂志,2017,8(6):364-370.
[2]孙迎娟,唐易琳,徐桂强,等.住院患者医院感染患病率调查分析[J].中华医院感染学杂志,2017,27(17):3925-3928.
[3]Magill SS,Edwards JR,Bamberg W,et al.Multistate pointprevalence survey of healthcare-associated infections[J].NEngl J Med,2014,370(13):1198-1208.
[4]Usarek P,Dobrzaniecka K,Saymanek-Majchrzak K,et al.Drug susceptibility assessment in Stenotrophomonas maltophilia strains isolated from the blood of organ transplantation recipients in a Warsaw Teaching Hospital during 2011to2014[J].Transpl P,2016,48(5):1411-1413.
[5]Leeyaphan C,Bunyaratavej S,Foongladda S,et al.Epidemiology,clinical characteristics,sites of infection and treatment outcomes of mucocutaneous candidiasis caused by non-albicans species of Candida at a dermatologic clinic[J].J Med Assoc Thai,2016,99(4):406-411.
[6]中华人民共和国卫生部.医院感染诊断标准试行[J].中华医学杂志,2001,81(5):314-320.
[7]Clinical and Laboratory Standards Institute.M100-S25.Performance standards for antimicrobial susceptibility testing;twenty-fifth informational supplement[S].2015.
[8]杨金燕,索继江,许玉冰,等.综合医院两年医院感染情况分析[J].中华医院感染学杂志,2016,26(8):1898-1900.
[9]吴安华,文细华,李春辉,等.2012年全国医院感染现患率与横断面抗菌药物使用率调查报告[J].中国感染控制杂志,2014,13(1):8-15.
[10]Kamalbeik S,Talaie H,Mahdavinejad A,et al.Multidrugresistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction:is there an association?[J].Korean J Anesthesiol,2014,66(4):295-299.
[11]Rosenthal VD,Al-Abdely HM,EI-Kholy AA,et al.International Nosocomial Infection Control Consortium report,data summary of 50 countries for 2010-2015:device-associated module[J].Am J Infect Control,2016,44(12):1495-1504.
[12]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[13]Goodman KE,Simner PJ,Tamma PD,et al.Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae(CRE)[J].Expert Rev Anti Infect Ther,2016,14(1):95-108.
[14]张小江,杨启文,王瑶,等.2016年北京协和医院细菌耐药性监测[J].协和医学杂志,2017,8(6):364-370.