一所综合医院连续三年医院感染发病率及病原菌耐药性监测报告  

Incidence and antimicrobial resistance of pathogens of healthcare-associated infection in a general hospital for three consecutive years

作　　者：邹秀珍[1] 茆海丰[1] 史家欣[1] 田丽梅[1] 刘善善[1] 潘立业[1] 陈亚男[1] 刘菁[1] 

机构地区：[1]连云港市第一人民医院,江苏连云港222002

出　　处：《中国感染控制杂志》2018年第2期97-102,共6页Chinese Journal of Infection Control

基　　金：国家自然科学基金项目(81300052);连云港市科技项目(SH1401)

摘　　要：目的了解2014—2016年某综合医院医院感染情况、病原菌分布及耐药性,为预防与控制医院感染提供依据。方法采用前瞻性和回顾性调查方法,收集该院2014年1月—2016年12月住院患者的临床资料,对医院感染病原菌分布及其耐药性进行统计分析。结果 2014—2016年共发生医院感染4 750例、5 352例次,医院感染发病率为2.19%,医院感染例次发病率2.46%。三年医院感染发病率分别为2.47%、2.07%和2.05%,呈下降趋势,差异具有统计学意义(χ2=36.217,P<0.01)。重症医学科、神经外科、烧伤整形科等科室医院感染发生率较高,以呼吸道、泌尿道、手术部位等为常见医院感染部位。医院感染分离病原菌以革兰阴性菌为主(76.10%)。大肠埃希菌对头孢菌素类、氟喹诺酮类药物耐药率较高(>60%);肺炎克雷伯菌对碳青霉烯类抗生素耐药性较高;铜绿假单胞菌对碳青霉烯类抗生素的耐药率呈逐年上升趋势(χ2=15.175,P=0.001);鲍曼不动杆菌对检测的抗菌药物耐药率均>50%。耐甲氧西林金黄色葡萄球菌占60%左右,耐甲氧西林凝固酶阴性葡萄球菌达80%以上,未分离到对万古霉素、利奈唑胺耐药的葡萄球菌属细菌。结论该院医院感染常见病原菌对抗菌药物耐药率较高。科学地开展医院感染监测,定期总结分析临床资料,对于指导合理使用抗菌药物,控制多重耐药菌株产生,降低医院感染具有重要的意义。Objective To understand the occurrence of healthcare-associated infection(HAI),distribution of pathogens,and drug resistance in a general hospital in 2014-2016,provide basis for prevention and control of HAI.Methods Clinical data of hospitalized patients from January 2014 to December 2016 were collected by prospective and retrospective investigation,distribution and drug resistance of pathogens causing HAI were statistically analyzed.Results From2014 to 2016,4 750 patients had 5 352 cases of HAI,incidence and case incidence of HAI were 2.19% and 2.46% respectively.Incidences of HAI in three years were 2.47%,2.07%,and 2.05% respectively,showing a decreased tendency,difference was statistically significant(χ~2=36.217,P<0.01).Incidences of HAI were high in intensive care unit,department of neurosurgery,as well as department of burn and plastic surgery,the common HAI sites were respiratory tract,urinary tract,and surgical sites.The main pathogens causing HAI were gram-negative bacteria(76.10%).Resistance rates of Escherichia coli to cephalosporins and fluoroquinolones were relatively higher(>60%);resistance rates of Klebsiella pneumoniae to carbapenems were relatively higher;resistance rates of Pseudomonas aeruginosato carbapenems showed a increased tendency year by year(χ~2=15.175,P=0.001);antimicrobial resistance rates of Acinetobacter baumannii were all>50%.Methicillin-resistant Staphylococcus aureus(SA)accounted for about 60% of SA,methicillin-resistant coagulase negative Staphylococcus(CNS)accounted for more than 80% of CNS,vancomycin-and linezolid-resistant Staphylococcus spp.were not found.Conclusion The common pathogens causing HAI in this hospital are higher.Scientific monitoring on HAI and regular analysis of clinical data are of great significance for guiding rational use of antimicrobial agents,controlling multidrug-resistant organisms,and reducing the occurrence of HAI.

关 键 词：医院感染 病原菌 耐药性 抗药性 微生物 合理用药 

分 类 号：R181.32[医药卫生—流行病学]