2018—2022年肝移植监护病房医院感染目标性监测结果分析  

Targeted surveillance results of healthcare-associated infection in the liver transplantation intensive care unit from 2018 to 2022

作　　者：杨亚 丁佳燕 黄妹[1] 陆峰[1] 沈瑞红[1] 秦娟秀[2] 周文琴[1] 傅小芳[1] 班海群 邓羽霄[3] 郑军华 YANG Ya;DING Jia-yan;HUANG Mei;LU Feng;SHEN Rui-hong;QIN Juan-xiu;ZHOU Wen-qin;FU Xiao-fang;BAN Hai-qun;DEND Yu-xiao;ZHENG Jun-hua(Department of Infection Management,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Critical Care Medicine,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Laboratory Medicine,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Urology,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院感染管理办公室,上海200127 [2]上海交通大学医学院附属仁济医院重症医学科,上海200127 [3]上海交通大学医学院附属仁济医院检验科,上海200127 [4]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《中国感染控制杂志》2024年第12期1514-1519,共6页Chinese Journal of Infection Control

基　　金：国家卫生健康委医院管理研究所“医疗质量循证管理持续改进研究项目”(YLZLXZ22K018);上海市浦江人才计划(22PJD041);上海市医院协会管理研究基金(X2023170)。

摘　　要：目的分析肝移植监护病房患者医院感染的发病特征,为有效防控肝移植术后感染提供依据。方法回顾性分析2018—2022年肝移植监护病房的医院感染目标性监测资料,分析发病率、发病趋势、感染部位、病原菌及其耐药情况。结果共监测3762例肝移植患者,发生医院感染106例、133例次,发病率为2.82%,例次发病率为3.54%,各年间比较差异无统计学意义(P=0.473)。感染主要发生在入住监护病房2周内,占85.85%;感染部位主要包括血液系统(26.32%)、呼吸系统(22.56%)和手术部位(19.55%);中心静脉置管、导尿管插管和呼吸机的平均使用率分别为85.77%、70.58%、40.83%,中心静脉导管相关血流感染(CLRBSI)、导尿管相关尿路感染(CAUTI)、呼吸机相关肺炎(VAP)的发病率分别为0.54‰、0.33‰、1.84‰。共检出病原菌131株,其中革兰阴性菌占38.17%,革兰阳性菌占29.77%,前三位病原体分别为肺炎克雷伯菌(15.27%)、屎肠球菌(11.45%)、鲍曼不动杆菌(9.16%)。结论应针对肝移植监护病房医院感染发病特征采取有效防控措施,遏制细菌耐药,减少肝移植术后医院感染。Objective To analyze the characteristics of healthcare-associated infection(HAI)in patients in liver transplantation intensive care unit(ICU),and provide basis for the effective prevention and control of liver post-transplantation infection.Methods Targeted surveillance data of HAI in liver transplantation ICU from 2018 to 2022 were analyzed retrospectively.Incidence,incidence trend,infection site,pathogens and drug resistance were analyzed.Results A total of 3762 liver transplantation patients were surveilled,106 patients developed 133 cases of HAI,with an incidence of 2.82% and a case incidence of 3.54%.There was no significant difference among the years(P=0.473).Infection mainly occurred within 2 weeks after admission to ICU,accounting for 85.85%.The main infection sites included blood system(26.32%),respiratory system(22.56%),and surgical site(19.55%).The average utilization rates of central veinous catheterization,urethral catheterization,and ventilator were 85.77%,70.58%,and 40.83%,respectively.The incidences of central line-associated bloodstream infection(CLABSI),catheter-associated urinary tract infection(CAUTI),and ventilator-associated pneumonia(VAP)were 0.54‰,0.33‰,and 1.84‰,respectively.A total of 131 strains of pathogens were detected,of which Gram-negative bacteria accounted for 38.17% and Gram-positive bacteria accounted for 29.77%.The top three pathogens were Klebsiella pneumoniae(15.27%),Enterococcus faecium(11.45%),and Acinetobacter baumannii(9.16%).Conclusion Effective prevention and control measures should be taken based on the characteristics of HAI in the liver transplantation ICU,so as to curb bacterial resistance and reduce liver post-transplantation HAI.

关 键 词：移植监护病房 医院感染 目标性监测 病原体 耐药性 肝移植 

分 类 号：R181.32[医药卫生—流行病学]