【作者】 付玉梅；

【导师】 蒋义国；

【作者基本信息】 广州医学院 ， 流行病与卫生统计学， 2010， 硕士

【摘要】 一、背景与目的:医院感染(Nosocomial?Infection)是指住院病人在医院内获得的感染,包括在住院期间发生的感染和在医院内获得出院后发生的感染,但不包括入院前已开始或入院时已存在的感染。医院工作人员在医院内获得的感染也属医院感染。医院感染已引起人们的高度重视。医院感染所造成的经济损失严重,在英国医院感染每年约花费医院10亿英镑,美国NNIS系统1986-1996年监测数据显示,每年由医院感染所引起的费用超过10亿美元,经济损失总和超过40亿美元。美国疾病预防与控制中心(CDC)一直对医院感染进行持续的、前瞻性的监测,监视医院感染发展的动向,不断地从中发现问题并进行研究,有针对性地提出预防与控制措施和策略,并组织实施。中国1986年开始组织医院感监测与控制,2001年全国医院感染率为5.2%? ,2003年为4.8%,2005年为4.8%。说明经过多年努力,我国医院感染的控制已经取得一定成绩。当今医学技术发生着日新月异的变化,医院感染的途径、易感人群和传染源也发生了复杂的变化,因此对医院感染监控工作需要长期进行,准确了解医院感染的变化趋势和分布动态。通过监测及时掌握准确信息,采取有效防治措施,从而达到预防和控制医院感染的发生,提高医疗质量。不同医院住院病人有不同特色,本次研究医院是一家以社区人群为主要病源的综合性二甲医院,它的特点是老年人多,相对大型医院危重患者和凝难病症少。目前正对社区人群为主要病源的医院感染发生情况还缺乏系统性调查,故本研究主要对广州医学院某二甲医院(以社区病源为主)2007年11月至2009年10月期间发生医院感染的情况、病原菌分布和抗菌谱进行详细的调查和分析,以提高对基层医院感状况的全面认识和了解,为预防和治疗感染、提高医疗质量提供科学依据。二、方法:1.统计方法对院2007.11-2009.10其间住院病人的病案进行回顾性查阅调查,收集所有住院病人的基本信息,疾病信息,用药情况,医院感染诊断,病原菌信息和药物敏感情况。医院感染的诊断来自医生在病案中的记录和医院感染管理科的相关监测资料。采用EXCEL8.0和SPSS 13.0软件对医院感染发病率、发病部位、科室分布和病原菌分布情况进行统计分析。2.致病菌的分离及鉴定按照《微生物检验操作规程》对临床标本进行培养,采用美国MicroSan WalkAway40 SI全自动微生物鉴定/药敏测试系统及K‐B法对细菌进行鉴定和药物敏感试验。K‐B法所用药物纸片及药敏板购自OX公司,结果按CLSI标准判定。质控菌株使用大肠埃希菌ATCC25922、金黄色葡萄球菌ATCC25913、铜绿假单胞菌ATCC27853及ESBLs阳性对照菌株肺炎克雷伯菌ATCC700603。产超广谱β-内酰氨酶菌的检测按照2005年美国临床实验室标准委员会(NCCL)要求进行操作和判断结果。三、结果:2年内有21567例住院患者,发生医院感染328例,感染率1.52 %,感染例次379例,例次感染率1.76 %,发病密度1.84‰;感染部位以呼吸道为主占54.09 % ,其次为泌尿道占21.11 %;长寿老人的发病率和发病密度均最高,分别为8.47%和3.92‰;住院时间越长发病率越高,发病密度变化不大,科室感染率及科室发病密度以重症监护病房最高分别是22.11%和16.38‰。病原菌以革兰阴性杆菌为主,检出241株,占63.59 %,见的有大肠埃希菌(31. 95 %)、肺炎克雷伯菌(19. 50 %)、铜绿假单胞菌(17. 84 %);兰阳性球菌检出82株,占21.64%,常见的有金黄色葡萄球菌(39.02 % ),凝固酶阴性葡萄球菌(35.37 %);真菌检出38株占10.02 %。药敏结果显示革兰阴性杆菌对亚胺培南、丁胺卡那霉素敏感率在80%以上,对西林类敏感率则低于30%;革兰阳性球菌对万古霉素和利奈唑烷敏感率在100%,目前没有发现对万古霉素和利奈唑烷耐药菌株,对氨苄西林和青霉素耐药率在90%以上。四、结论重症监护室、肿瘤科、呼吸科住院时间长,医院感染发生率与发病密度均较高,是重点监测目标,住院患者医院感染病原菌主要是革兰阴性杆菌,临床用药应根据药敏结果合理使用抗生素,减少细菌耐药和真菌感染,从而有效预防和控制感染,缩短病人住院时间性。更多还原

【Abstract】 Background and purposeNosocomial infections are infections which are results of treatment in the hospital. Infections are considered nosocomial if they occurred during hospitalization or acquired in hospital but appeared after discharge, not including the infections existed before hospitalization. In addition, Hospital staff’s infections acquired in the hospital are also considered as nosocomial infections. Nosocomial infections have attracted much attention. In England, the hospital spend about ten million pounds per year in the study of nosocomial infections, and the Centre for Disease Control and Prevention (CDC) of the United States has been on the constant prospective surveillance, monitoring of the development trend of nosocomial infections and studying constantly on the issues identified from the survey. At the same time, the U.S. CDC puts forward procedures for the prevention and control of nosocomial infections, while also organizes the implement. China in 2001, the incidence rate of nosocomial infections was 5.2% and 4.8% in 2003, 4.8% in 2005. Figures show that the control of nosocomial infections in China has made great achievements after years of efforts. Now medical technology is undergoing rapid change, at the same time, the complicated changes of the transmission of nosocomial infections, susceptible populations and the pathogens have taken place. Therefore, the long-term surveillance of nosocomial infection requires ongoing, in order to understand the trend and dynamic distribution of nosocomial infections accurately. The effective preventive measures are carried out after accessing to accurate information of nosocomial infections timely through surveillance, in order to prevent and control the incidence rate of nosocomial infections. Patients in different hospitals have different characteristics. This study is carried out in a comprehensive local hospital, the main source of which is community groups characterized by older. There will be less critically ill patients and less difficult cases compared with the large hospital. Currently, community groups as the main source of outbreaks, the incidence of nosocomial infection are also a lack of systematic investigation. For this reason, this study aimed through the detailed investigation and analysis on the hospital infections cases, pathogen distribution and antimicrobial spectrum of nosocomial infection in a local hospital of Guangzhou Medical College from November 2007 to October 2009 to improve the overall awareness and understanding to the situation of nosocomial infections, provide a scientific proof for the prevention and treatment of infection and improve health care quality.Methods1. Statistical methodsThe retrospective investigation carried out basing on the hospital’s medical records during 2007.11-2009.10 was carried out, with the collection of basic information, disease information, drug use, nosocomial infection diagnosis, pathogens and drug-sensitive case information of all hospital patients. The diagnosis of nosocomial infection based on the medical records from doctors and the monitoring data from the hospital infection control Department. Moreover the incidence of hospital infection, disease position, department distribution and the distribution of pathogenic bacteria were analyzed by using SPSS 13.0 and EXCEL8.0 . 2. Isolation and identification of pathogensThe clinical samples were cultured according to Microbial Laboratory Procedures,while bacterial identification and antimicrobial susceptibility test were conducted using the United States MicroSan WalkAway40 SI automated microbial identification / susceptibility testing system and the KB method. The drug sensitive paper and board using in KB method were purchased from OX Company, and the results were determined according to CLSI standards. The quality control strains were using Escherichia coli ATCC25922, Staphylococcus aureus ATCC25913, Pseudomonas aeruginosa ATCC27853 and ESBLs-positive control strains of Klebsiella pneumoniae ATCC700603. The detection of extended-spectrumβ-lactamase producing bacteria was judged according to the 2005 Committee for Clinical Laboratory Standards (NCCL).ResultsThere were 328 cases of nosocomial infection among 21567 cases of hospitalized patients from November 2007 to October 2009. Through the statistical research, the infection rate was 1.52%, infection in patients with sub-379 cases, case infection rate was 1.76%, the incidence density rate was 1.84‰; the major site was respiratory tract infections accounted for 54.09%, followed by the urinary tract accounted for 21.11%; the incidence rate of disease and incidence density rate of elderly groups were the highest, respectively 8.47% and 3.92‰; hospitalization time was longer as the incidence rate of nosocomial infections was higher, while incidence density changed little. The incidence rate and density rate of departments were the highest respectively 22.11% and 16.38‰in intensive care unit. Most pathogens were gram-negative bacilli accounting for 63.59% for 241 cases detection, E. coli (31.95%), Klebsiella pneumoniae (19.50%), Pseudomonas aeruginosa (17.84%) would be often found. At the same time, 82 Gram-positive bacteria strains were detected accounted for 21.64%. The common Gram-positive bacteria were Staphylococcus aureus (39.02%), coagulase-negative staphylococci (35.37%); fungi detected in 38 strains accounted for 10.02%. Susceptibility results showed that Gram-negative bacteria to imipenem, amikacin sensitivity rate was 80% ,while thesensitivity rate to penicillin class was less than 30%; Gram-positive cocci to vancomycin and linezolid sensitivity was 100%. Currently vancomycin and linezolid resistant strains haven’t been found, ant the rate of resistant to ampicillin and penicillin was more than 90%.ConclusionsIntensive care unit, cancer division and respiratory division, which hospitalization time was longer and hospital infection rates and incidence density were higher, were the focal point monitoring objectives. Major pathogens of nosocomial infections was Gram-negative bacteria, and clinical treatment should be based on the rational use of drug sensitivity test , to reduce fungal infections and drug resistance, in order to prevent and control nosocomial infections effectively and shorter hospitalization timing.更多还原