耳鼻喉科手术患者术前病原菌筛查结果分析  

Screening of pathogens for patients of otolaryngology department before surgery

作　　者：姚惠 李占结 秦颖 李松琴 刘娟 臧凤 张永祥 YAO Hui;LI Zhan-jie;QIN Ying;LI Song-qin;LIU Juan;ZANG Feng;ZHANG Yong-xiang(Affiliated Hospital to Yangzhou University,Yangzhou,Jiangsu 22500l,China;不详)

机构地区：[1]扬州大学临床医学院院感管理科,江苏扬州225001 [2]南京医科大学第一附属医院感染管理处,江苏南京210029

出　　处：《中华医院感染学杂志》2023年第10期1535-1539,共5页Chinese Journal of Nosocomiology

基　　金：国家科技攻关基金资助项目(2020YFC0848100);江苏省人民医院第三期优秀中青年人才培养项目(YNRCQN0314);南京医科大学第一附属医院青年基金培育计划(PY2022017)。

摘　　要：目的回顾性分析耳鼻喉科手术患者连续8年主动筛查结果,根据分析结果为临床制订筛查方法提供依据。方法通过杏林医院感染实时监控系统调取2013年1月-2020年12月南京医科大学第一附属医院耳鼻喉科住院手术患者临床资料,分析检出病原菌分布,以及患者医院感染发生率的影响因素。结果连续8年耳鼻喉科住院手术患者主动筛查检出病原菌阳性率为12.60%(980/7775),多药耐药菌(MDRO)检出率为12.86%(126/980);共检出病原菌1062株,革兰阳性菌686株(64.60%),革兰阴性菌326株(30.69%),真菌50株(4.71%);126株多药耐药菌分别为耐甲氧西林金黄色葡萄球菌(MRSA)110株,耐碳青霉烯类铜绿假单胞菌(CRPA)7株,耐碳青霉烯类鲍氏不动杆菌(CRAB)6株,耐碳青霉烯类肠杆菌目细菌(CRE)3株。病原菌和MDRO检出阳性率与年龄、疾病种类相关(P<0.05);患者医院感染率与性别、年龄、检出病原菌有关(P<0.05);检出病原菌患者发生医院感染与性别、年龄>65岁、鼻部和咽喉部疾病、使用抗菌药物有关(P<0.05)。结论针对耳鼻喉科的男性老年患者,鼻咽部疾病患者主动筛查检出病原菌需要关注,严格落实各项院感防控措施减少医院感染的发生。OBJECTIVE To retrospectively analyze the result of active screening for surgery patients of otolaryngology department in 8 consecutive years so as to provide basis for formulating screening methods based on the result.METHODS From Jan 2013 to Dec 2020,the clinical data were collected from the patients who were hospitalized in otolaryngology department of The First Affiliated Hospital of Nanjing Medical University by Xinglin Nosocomial Infection real-time monitoring system,the distribution of the isolated pathogens was observed,and the influencing factors for the nosocomial infection were analyzed.RESULTS The positive rate of active screening of pathogens was 12.60%(980/7775)among the hospitalized patients of otolaryngology department in the 8 consecutive years,and the isolation rate of multidrug-resistant organisms(MDROs)was(126/980).Totally 1062 strains of pathogens were isolated,686(64.60%)of which were gram-positive bacteria,326(30.69%)were gram-negative bacteria,and 50(4.71%)were fungi.Among 126 strains of MDROs,there were 110 strains of methicillin-resistant Staphylococcus aureus(MRSA),7 strains of carbapenem-resistant Pseudomonas aeruginosa(CRPA),6 strains of carbapenem-resistant Acinetobacter baumannii(CRAB)and 3 strains of carbapenem-resistant Enterobacteriaceae(CRE).The positive rates of pathogens and MDROs were associated with the age and type of disease(P<0.05);the incidence of nosocomial infection was associated with the gender,age and isolated pathogens(P<0.05);the occurrence of nosocomial infection in the patients was associated with the gender,more than 65 years of age,nasopharyngeal diseases and use of antibiotics(P<0.05).CONCLUSION It is necessary to pay close attention to the active screening of pathogens for the male elderly patients with nasopharyngeal diseases in otolaryngology department and rigidly implement the prevention measures so as to reduce the incidence of nosocomial infection.

关 键 词：耳鼻喉科手术 主动筛查 术后感染 病原菌 多药耐药菌 危险因素 

分 类 号：R762[医药卫生—耳鼻咽喉科]