某三级综合医院整体搬迁前后多重耐药菌的变迁  

Changes of multidrug-resistant organisms in a tertiary general hospital around overall relocation

作　　者：张菊[1] 李小静[1] 陈敏[2] 李刚[3] 罗敏 陈洁[5] 曾侠[6] 杨俊华[1] 曾凤梅 马莉[7] 雷虹[8] 彭丽蒙 ZHANG Ju;LI Xiaojing;CHEN Min;LI Gang;LUO Min;CHEN Jie;ZENG Xia;YANG Junhua;ZENG Fengmei;MA Li;LEI Hong;PENG Limeng(Department of Nosocomial Infection Management,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Ophthalmology,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Traditional Chinese Medicine,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Clinical Laboratory,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Surgical Anesthesia Center,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Gastroenterology,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Urology,West China Hospital,Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Health Checkup Center,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Ping’an Community Health Center of Longquanyi District,Chengdu,Sichuan 610100,P.R.China)

机构地区：[1]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)医院感染管理科,成都610100 [2]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)眼科,成都610100 [3]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)中医科,成都610100 [4]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)检验科,成都610100 [5]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)手术麻醉中心,成都610100 [6]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)消化内科,成都610100 [7]四川大学华西医院泌尿外科,成都610100 [8]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)健康体检中心,成都610100 [9]成都市龙泉驿区平安社区卫生服务中心,成都610100

出　　处：《华西医学》2022年第3期369-374,共6页West China Medical Journal

基　　金：四川省预防医学会医院感染预防与控制研究基金(SCGK202120);四川省中医药管理局中医药科研专项课题(2020LC0026);四川省中医药信息学会舒适化医疗(新晨基金)专项科研课题(20200117);成都市医学科研课题(2020084);成都市龙泉驿区卫健系统科研课题(WJKY003)。

摘　　要：目的了解成都市龙泉驿区第一人民医院整体搬迁前后多重耐药菌的变迁情况。方法回顾性分析成都市龙泉驿区第一人民医院2016年12月31日整体搬迁前后,即2015年-2016年搬迁前与2017年-2020年搬迁后院内多重耐药菌检出率与医院感染变化情况。结果共计送检合格标本83634份,检出病原菌8945株,检出率为10.70%,不同年份病原菌检出率有逐年增加趋势(χ^(2)_(趋势)=8.722,P=0.003);其中检出多重耐药菌1551株,多重耐药菌检出率为17.34%,不同年份多重耐药菌检出率有逐年增加趋势(χ^(2)_(趋势)=11.140,P=0.001);搬迁前的病原菌检出率低于搬迁后,差异有统计学意义(9.64%vs.11.08%;χ^(2)=35.408,P<0.001),搬迁前后的多重耐药菌检出率差异无统计学意义(16.32%vs.17.66%;χ^(2)=2.050,P=0.152)。2015年-2020年间,痰+咽拭子(χ^(2)_(趋势)=81.764,P<0.001)和分泌物+脓液(χ^(2)_(趋势)=56.311,P<0.001)标本的细菌检出率有逐年增加趋势,血液(χ^(2)_(趋势)=110.400,P<0.001)、尿液(χ^(2)_(趋势)=11.919,P=0.001)和无菌体液(χ^(2)_(趋势)=20.158,P<0.001)标本的细菌检出阳性率有逐年降低趋势。大肠埃希菌(χ^(2)_(趋势)=21.742,P<0.001)、金黄色葡萄球菌(χ^(2)_(趋势)=47.049,P<0.001)和铜绿假单胞菌(χ^(2)_(趋势)=66.625,P<0.001)的多重耐药菌检出率有逐年增加趋势,肺炎克雷伯菌(χ^(2)趋势=2.929,P=0.087)和鲍曼不动杆菌(χ^(2)_(趋势)=0.498,P=0.481)多重耐药菌检出率不呈线性变化趋势,但鲍曼不动杆菌的多重耐药菌检出率在2017年有明显下降。检出的目标监测菌耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肠杆菌科细菌和耐碳青霉烯类铜绿假单胞菌中,医院感染构成比呈逐年下降趋势(χ^(2)_(趋势)=4.581,P=0.032;χ^(2)_(趋势)=8.031,P=0.005;χ^(2)_(趋势)=6.692,P=0.010);检出的耐碳青霉烯类鲍曼不动杆菌中,医院感染构成比不呈线性变化趋势(χ^(2)_(趋势)=0.597,P=0.440);耐万古霉素肠球菌仅2Objective To investigate the changes of multidrug-resistant organisms(MDROs)in the First People’s Hospital of Longquanyi District of Chengdu around its overall relocation.Methods The First People’s Hospital of Longquanyi District of Chengdu was overall relocated on December 31st,2016.The detection rates of MDROs and the changes in nosocomial infections before the relocation(from 2015 to 2016)and after the relocation(from 2017 to 2020)were retrospectively analyzed.Results A total of 83634 qualified specimens were submitted for inspection,8945 strains of pathogenic bacteria were detected,and the detection rate of pathogenic bacteria was 10.70%,showing an increasing trend in yearly detection rates of pathogenic bacteria(χ~2_(trend)=8.722,P=0.003);among them,1551MDRO strains were detected,and the detection rate of MDROs was 17.34%,showing an increasing trend in yearly detection rates of MDROs(χ~2_(trend)=11.140,P=0.001).The detection rate of pathogenic bacteria before relocation was lower than that after relocation,and the difference was statistically significant(9.64%vs.11.08%;χ^(2)=35.408,P<0.001);there was no significant difference in the detection rate of MDROs before and after relocation(16.32%vs.17.66%;χ^(2)=2.050,P=0.152).From 2015 to 2020,the detection rates of pathogenic bacteria from sputum+throat swab specimens(χ^(2)_(trend)=81.764,P<0.001)and secretion+pus specimens(χ^(2)_(trend)=56.311,P<0.001)showed increasing trends,while the detection rates of pathogenic bacteria from blood specimens(χ^(2)_(trend)=110.400,P<0.001),urine specimens(χ^(2)_(trend)=11.919,P=0.001),and sterile body fluid specimens(χ^(2)_(trend)=20.158,P<0.001)showed decreasing trends.The MDRO detection rates of Escherichia coli(χ^(2)_(trend)=21.742,P<0.001),Staphylococcus aureus(χ^(2)_(trend)=47.049,P<0.001),and Pseudomonas aeruginosa(χ^(2)_(trend)=66.625,P<0.001)showed increasing trends,while the MDRO detection rates of Klebsiella pneumoniae(χ^(2)_(trend)=2.929,P=0.087)and Acinetobacter baumannii(χ^(2)_(trend)=0.498,P=0.4

关 键 词：三级综合医院 整体搬迁 多重耐药菌 变迁 

分 类 号：R446.5[医药卫生—诊断学]