摘要
目的了解不同级别医院ICU医院感染的发生情况、病原菌分布及耐药性,以指导临床合理使用抗菌药物。方法在江苏省医院感染质控中心(NIQCC)的统一部署下,全省99所二级医院和63所三级医院按照卫生部《医院感染监测规范》开展ICU医院感染目标性监测,利用Stata10.0版软件对2011-2012年不同级别医院的监测资料进行对比分析。结果二级医院与三级医院ICU医院感染调整千日感染率基本相同,分别为5.43‰和5.31‰,但导管相关性血流感染(CRBSI)和导尿管相关性尿路感染(CAUTI)的发生率三级医院高于二级医院,呼吸机相关性肺炎(VAP)的发生率二级医院高于三级医院;两组医院感染部位前4位均依次为下呼吸道、VAP、CAUTI和CRBSI;前6位病原菌均分别为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、肠球菌属,二级医院分别占20.74%、13.07%、13.19%、7.70%、8.54%、2.74%,三级医院分别占23.86%、12.12%、11.43%、5.58%、7.77%、3.98%;医院感染病原菌的耐药性普遍较高,多药耐药鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌检出率三级医院分别为69.05%、13.77%、13.61%、77.26%、7.97%,明显高于二级医院的59.73%、15.00%、3.04%、58.12%、1.69%。结论 ICU患者是医院感染的高危人群,目标性监测可了解医院感染的高危因素并及时采取干预措施,有效地降低ICU患者医院感染的发生率。
OBJECTIVE To investigate the incidence of nosocomial infections （NIs）, distribution, and drug resist- ance of pathogens in ICUs in hospitals witTh different grades so as to guide appropriate use of antibiotics. METHODS According to the arrangement by the province nosocomial infection quality control center （NIQCC） and surveillance standard of nosocomial infections by the Ministry of Health, the targeted surveillance of nosocomial infections was carried out in ICUs in 99 grade 2 hospitals and 63 grade 3 hospitals. The data of surveillance was collected every 3 months and then was analyzed with MINKE nosocomial infections management software by NIQCC. The data of surveillance from different grades of hospitals from 2011 to 2012 were comparatively analyzed with Stata 10.0 software. RESULTS The adjusted infection rates per 1000 bed days in grade 2 and grade 3 hospi- tals were similar, which were 5.43‰ and 5.31‰, respectively. However, the incidence of GRBSI and CAUTI of grade 3 hospitals were higher than those of grade 2 hospitals. On contrast, the incidence of VAP was lower in grade 3 hospitals than that in grade 2 hospitals. The most common infections were the lower respiratory tract in- fection, VAP, CAUTI ,and CRBSI. The most frequently isolated species of pathogens causing NIs were Acineto- bacter baumannii , Pseudomonas aeruginasa , Klebsiella pneumoniae , Staphylococcus aureus , F.scherichia coli , and Enteroeoccus, which accounted for 20. 74% , 13.07,13. 19% , 7. 70%, 8. 54%, and 2. 74, respectively in the grade 2 hospitals and accounted for 23.86 %, 12.12%, 11.43 %, 5.58%, 7.71 %, and 3.98, respectively in the grade 3 hospitals . The pathogens causing nosocomial infections were highly resistant ,the isolation rates of multi- drug-resistant A. baumannii, E. coli, K. pneumoniae, MRSA, vancomycin-resistant Enterococci in the grade 3 hospitals were respectively 69. 05%, 13. 77%, 13. 61%, 77. 26%, and 7. 97%, significantly higher than 59.73% ,15.00%, 3.04% ,58.12% , and 1.69% of the grade 2 hospitals. CONCLUSION The patients in ICUs are at high risk of NIs. The implementation of targeted surveillance can find out the risk factors of NIs so as to take effective intervention measures and reduce the incidence of NIs in the ICU patients.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第7期1515-1517,共3页
Chinese Journal of Nosocomiology
