青海省某三甲医院2010—2017年医院感染现患率调查
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摘要
目的了解青海省某院2010—2017年医院感染现患情况及变化趋势。方法采用病历调查与床旁调查相结合的方法,对2010—2017年各年份该院某日的所有住院患者医院感染情况、抗菌药物使用情况、医院感染病原体及治疗性使用抗菌药物细菌培养送检情况进行调查。结果 8次横断面调查共调查住院患者12 446例,发生医院感染488例,555例次。医院感染现患率为3. 92%,例次现患率为4. 46%。各年份医院感染现患率为2. 93%～5. 70%。医院感染现患率最高的科室为综合重症监护病房(ICU),为58. 72%;医院感染部位主要为下呼吸道(279例次)。各年份抗菌药物使用率比较,差异有统计学意义(χ~2=135. 98,P <0. 01),由2010年的55. 56%下降至2017年的16. 05%。抗菌药物使用以治疗用药为主(65. 74%),治疗用药所占比率逐渐下降;以一联用药为主(91. 52%),2011—2017年三联及以上用药比率均为0。各年份治疗性使用抗菌药物病原学送检率比较,差异有统计学意义(χ~2=57. 48,P <0. 05)。共检出病原体203株,以革兰阴性(G~-)菌为主,占67. 98%(138株),革兰阳性(G~+)菌占25. 62%(52株),其余为真菌及其他病原体。结论该院医院感染现患率总体较平稳,抗菌药物使用及治疗性使用抗菌药物病原学送检逐步得到规范,需密切关注ICU、神经外科、血液科等科室的医院感染管理工作。
Objective To understand the current situation and changing trend of healthcare-associated infection( HAI) in a hospital of Qinghai Province from 2010 to 2017. Methods Medical record review and bedside survey was adopted to investigate the occurrence of HAI,antimicrobial use,pathogens causing HAI,and bacterial culture( therapeutic antimicrobial use) of all inpatients in one day of each year from 2010 to 2017. Results A total of 12446 inpatients were investigated in 8 cross-sectional surveys,488 patients had 555 cases of HAI. HAI rate and HAI case rate were 3. 92 % and 4. 46 % respectively. Prevalence of HAI in each year were 2. 93 %-5. 70 %. The highest prevalence of HAI was found in ICU( 58. 72 %),and the main site of HAI was lower respiratory tract( n = 279).There was a significant difference in the usage rate of antimicrobial agents in each year( χ~2= 135. 98,P < 0. 01),decreased from 55. 56 % in 2010 to 16. 05 % in 2017. The use of antimicrobial agents were mainly therapeutic(65. 74%),proportion of therapeutic antimicrobial use gradually declined; 91. 52% were antimicrobial monotherapy,proportion of combined use of at least three antimicrobial agents was 0 in 2011-2017. There was a significant difference in pathogenic detection of therapeutic antimicrobial use among each year( χ~2= 57. 48,P < 0. 05). A total of 203 pathogens were isolated,the main pathogens were gram-negative bacteria( n = 138,67. 98 %) and gram-positive bacteria( n = 52,25. 62 %),followed by fungi and other pathogens. Conclusion The prevalence of HAI in this hospital is generally stable,antimicrobial use and pathogenic detection of therapeutic antimicrobial use are gradually standardized,close attention should be paid to the management of HAI in ICU,departments of neurosurgery and hematology.
Objective To understand the current situation and changing trend of healthcare-associated infection( HAI) in a hospital of Qinghai Province from 2010 to 2017. Methods Medical record review and bedside survey was adopted to investigate the occurrence of HAI,antimicrobial use,pathogens causing HAI,and bacterial culture( therapeutic antimicrobial use) of all inpatients in one day of each year from 2010 to 2017. Results A total of 12446 inpatients were investigated in 8 cross-sectional surveys,488 patients had 555 cases of HAI. HAI rate and HAI case rate were 3. 92 % and 4. 46 % respectively. Prevalence of HAI in each year were 2. 93 %-5. 70 %. The highest prevalence of HAI was found in ICU( 58. 72 %),and the main site of HAI was lower respiratory tract( n = 279).There was a significant difference in the usage rate of antimicrobial agents in each year( χ~2= 135. 98,P < 0. 01),decreased from 55. 56 % in 2010 to 16. 05 % in 2017. The use of antimicrobial agents were mainly therapeutic(65. 74%),proportion of therapeutic antimicrobial use gradually declined; 91. 52% were antimicrobial monotherapy,proportion of combined use of at least three antimicrobial agents was 0 in 2011-2017. There was a significant difference in pathogenic detection of therapeutic antimicrobial use among each year( χ~2= 57. 48,P < 0. 05). A total of 203 pathogens were isolated,the main pathogens were gram-negative bacteria( n = 138,67. 98 %) and gram-positive bacteria( n = 52,25. 62 %),followed by fungi and other pathogens. Conclusion The prevalence of HAI in this hospital is generally stable,antimicrobial use and pathogenic detection of therapeutic antimicrobial use are gradually standardized,close attention should be paid to the management of HAI in ICU,departments of neurosurgery and hematology.
引文
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[5]张亮,荚恒敏,杨会志.某综合性医院3年医院感染现患率调查[J].中国感染控制杂志,2017,16(6):558-560.
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[7]申俊萍,杨芸,薛平.山西省2012—2016年医院感染现患率及抗菌药物使用变化趋势及分析[J].现代医院管理,2017,15(2):5-8.
[8]何建云,许磊. 2013—2015年综合医院医院感染现患率调查与分析[J].预防医学情报杂志,2017,33(1):56-60.
[9]叶丹,毛璞,李常安,等. 2008—2013年医院感染现患率调查[J].中华医院感染学杂志,2015,25(24):5728-5730.
[10]劳一群,曾娟,柳剑,等. 2010—2014年医院感染现患率调查分析[J].中华医院感染学杂志,2017,27(2):443-447.
[11] Cai Y,Venkatachalam I,Tee NW,et al. Prevalence of healthcare-associated infections and antimicrobial use among adult inpatients in Singapore acute-care hospitals:results from the first national point prevalence survey[J]. Clin Infect Dis,2017,64(Suppl 2):S61-S67.
[12] van der Kooi TI,Manni3n J,Wille JC,et al. Prevalence of nosocomial infections in The Netherlands,2007-2008:results of the first four national studies[J]. J Hosp Infect,2010,75(3):168-172.
[13]韩阳,潘海峰,范引光,等.某三甲医院2010—2014年住院患者医院感染现患率调查研究[J].中华疾病控制杂志,2016,20(1):58-62.
[14]蒙巍,金宗英,骆丽平,等. 2014—2016年某中医医院现患率调查分析[J].中华医院感染学杂志,2017,27(4):823-826.
[15]顾成武,惠亚,江冬萍,等.某院2013—2016年医院感染现患率与抗菌药物使用趋势分析[J].现代医药卫生,2018,34(1):5-8.
[16]剧志英,王涛,曾艳,等.某军队医院2014—2017年医院感染现患率调查结果分析[J].中国消毒学杂志,2017,34(12):1138-1140.
[2]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京,2001.
[3]任南,文细毛,吴安华. 2014年全国医院感染横断面调查报告[J].中国感染控制杂志,2016,15(2):83-87.
[4]任思思,万丽,傅启会,等. 2010—2015年医院感染现患率调查[J].热带医学杂志,2017,17(9):1240-1243.
[5]张亮,荚恒敏,杨会志.某综合性医院3年医院感染现患率调查[J].中国感染控制杂志,2017,16(6):558-560.
[6]冯伟.我院2015~2016年住院患者感染现患率和易感因素调查分析[J].中医药管理杂志,2017,25(21):22-25.
[7]申俊萍,杨芸,薛平.山西省2012—2016年医院感染现患率及抗菌药物使用变化趋势及分析[J].现代医院管理,2017,15(2):5-8.
[8]何建云,许磊. 2013—2015年综合医院医院感染现患率调查与分析[J].预防医学情报杂志,2017,33(1):56-60.
[9]叶丹,毛璞,李常安,等. 2008—2013年医院感染现患率调查[J].中华医院感染学杂志,2015,25(24):5728-5730.
[10]劳一群,曾娟,柳剑,等. 2010—2014年医院感染现患率调查分析[J].中华医院感染学杂志,2017,27(2):443-447.
[11] Cai Y,Venkatachalam I,Tee NW,et al. Prevalence of healthcare-associated infections and antimicrobial use among adult inpatients in Singapore acute-care hospitals:results from the first national point prevalence survey[J]. Clin Infect Dis,2017,64(Suppl 2):S61-S67.
[12] van der Kooi TI,Manni3n J,Wille JC,et al. Prevalence of nosocomial infections in The Netherlands,2007-2008:results of the first four national studies[J]. J Hosp Infect,2010,75(3):168-172.
[13]韩阳,潘海峰,范引光,等.某三甲医院2010—2014年住院患者医院感染现患率调查研究[J].中华疾病控制杂志,2016,20(1):58-62.
[14]蒙巍,金宗英,骆丽平,等. 2014—2016年某中医医院现患率调查分析[J].中华医院感染学杂志,2017,27(4):823-826.
[15]顾成武,惠亚,江冬萍,等.某院2013—2016年医院感染现患率与抗菌药物使用趋势分析[J].现代医药卫生,2018,34(1):5-8.
[16]剧志英,王涛,曾艳,等.某军队医院2014—2017年医院感染现患率调查结果分析[J].中国消毒学杂志,2017,34(12):1138-1140.