全科医学科住院患者医院感染病原菌分布与危险因素  

Pathogen distribution and risk factors of nosocomial infections in inpatients of department of general practice

作　　者：姬文灿 王参军[2] 袁晨燕[2] JI Wencan;WANG Canjun;YUAN Chenyan(Department of General Practice,the Affiliated Zhongda Hospital of Southeast University,Nanjing,Jiangsu 210009,China)

机构地区：[1]东南大学附属中大医院全科医学科,江苏南京210009 [2]东南大学附属中大医院医学检验科,江苏南京210009

出　　处：《中国微生态学杂志》2018年第9期1041-1046,共6页Chinese Journal of Microecology

基　　金：国家自然科学基金青年基金(81501525)

摘　　要：目的分析2014年7月-2017年6月我院全科医学科住院患者医院感染的病原菌分布及危险因素,为临床合理应用抗生素提供依据。方法采用Vitek 2Compact全自动细菌鉴定及药敏分析系统进行病原菌的鉴定,采用纸片扩散法(K-B法)和MIC法测定其对抗菌药物的敏感性,根据美国临床实验室标准化协会(CLSI)2014年标准对药敏试验结果进行分析判断。结果 1 532例全科医学科住院患者发生医院感染190例、245例次,医院感染率和例次感染率分别为12.40%和15.99%。感染部位以呼吸系统、泌尿系统和消化系统为主,分别占50.61%、21.63%和12.65%。共分离出病原菌125株,其中革兰阴性菌79株(63.20%),革兰阳性菌38株(30.40%)。药敏结果显示:大肠埃希菌对氨苄西林的耐药率最高,为94.74%,对美罗培南和亚胺培南的耐药率均为0.00%;肺炎克雷伯菌对氨苄西林的耐药率最高,为95.45%,对美罗培南、亚胺培南的耐药率均为0.00%;鲍曼不动杆菌对头孢替坦的耐药率最高,为100.00%,对阿米卡星的耐药率最低,为20.00%;金黄色葡萄球菌对青霉素G的耐药率最高,为100.00%,对万古霉素、替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;表皮葡萄球菌对青霉素G的耐药率最高,为100.00%,对万古霉素、替考拉宁、替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;屎肠球菌对克林霉素的耐药率最高,为100.00%,对替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;住院时间>30d、糖尿病、鼻饲管置管、泌尿道插管、深静脉置管和应用抗菌药物是全科医学科住院患者医院感染的独立危险因素(P<0.05)。结论应针对全科医学科住院患者医院感染的病原菌特点及危险因素,加强防控以降低医院感染率。Objective To analyze the distribution of pathogens and risk factors of nosocomial infections in the general practice department of our hospital from July 2014 to June 2017,and provide evidence for clinical rational use of antibiotics.Methods The pathogens were identified by using Vitek 2 Compact automatic bacterial identification and drug sensitivity analysis system.The susceptibility to antibiotics was determined by disk diffusion method（K-B method）and MIC method.The results of drug sensitivity test were analyzed and assessed according to the standards by American Association of Clinical Laboratory Standards Institute（CLSI）in 2014.Results There were 245 cases of nosocomial infections involving 190 inpatients among the1,532 inpatients in the general practice department;the infection rate and incidence rate were 12.40% and15.99%,respectively.Respiratory system,urinary tract and digestive system were the main sites of infection,accounting for 50.61%,21.63% and 12.65%respectively.Totally 125 strains of pathogenic bacteria were isolated,of which 76 were Gram-negative bacteria（60.80%）and 38 Gram-positive bacteria（30.40%）.The resistance rate of Escherichia coli to Ampicillin was the highest（94.74%）,and those to Meropenem and Imipenem were 0.00%.The resistance rate of Klebsiella pneumoniae to Ampicillin was the highest（95.45%）,and those to Meropenem and Imipenem were 0.00%.The resistance rate of Acinetobacter baumannii to Cefotetan was the highest（100.00%）,and that to Amikacin was the lowest（20.00%）.The resistance rate of Staphylococcus aureus to Penicillin G was the highest（100.00%）,and those to Vancomycin,Tegicycline,Linezolid and Quinaputin/Dafoptin were all 0.00%.The resistance rate of Staphylococcus epidermidis to Penicillin G was the highest（100.00%）,and those to Vancomycin,Teicoplanin,Teicycline,Linazolamine,Linezolid and Quinaputin/Dafoptin were all 0.00%.The resistance rate of Enterococcus faeciumto Clindamycin was the highest（100.00%）,and those to Tegacycline,Linezol

关 键 词：全科医学 住院患者 医院感染 危险因素 

分 类 号：R195.4[医药卫生—卫生统计学]