2009年上海市医院感染现患率调查结果分析

Prevalence Surveillance of Healthcare Associated Infections in 70 Shanghai Hospitals

目的了解上海市二、三级医院的医院感染现况。方法按照卫生部《医院感染诊断标准》,采取床旁调查和查阅住院病历相结合的方法 ,对2009年10月份上海市二甲以上70所医院进行医院感染现患率调查。结果实际调查49 458例,实查率99.58%,发现医院感染1962例,感染率3.97%,2193例次感染,例次感染率4.43%;调查当天有19 451例使用抗菌药物,使用率39.32%;感染部位前5位依次为下呼吸道(45.46%)、泌尿道(15.96%)、上呼吸道(10.44%)、手术部位(6.38%)、腹腔内组织(4.79%);检出病原菌1569株,大多为革兰阴性杆菌(57.55%),依次为铜绿假单胞菌230株(14.66%)、鲍氏不动杆菌157株(10.01%)、大肠埃希菌147株(9.37%),检出MRSA 116株(7.39%)、真菌277株(17.66%);多因素分析显示,男性、老年患者(≥65岁)、过长的住院时间(≥30 d)、入住ICU,是医院感染的独立危险因素。结论上海市最常见的医院感染为下呼吸道感染,应加强对医院重点科室的目标性监测和下呼吸道感染的干预措施。

OBJECTIVE To evaluate the prevalence of healthcare associated infections （HAIs） in Shanghai. METHODS A survey of HAIs was undertaken in 70 hospitals in Oct 2009, HAIs were diagnosed according to the criteria set up by the Minister of Health. Infection control professionals investigated each admitted patient at bedside in order to detect each HAL RESULTS A total of 49458 patients were surveyed and the actual investigated rate was 99.58%. 1962 patients with HAIs were detected, and 2193 cases of HAIs, the prevalence was 4.43%. Among 49458 patients, 19451 patients （39.32%） were using antimicrobial agents at the survey day. The top five HAIs were lower respiratory tract infection （45.46%）, urinary tract infection （15.96%）, upper respiratory tract infection （10.44 %）, surgical site infection （6.38 %） and intro-abdominal infection （4.79%） , respectively. 1569 strains of pathogens were isolated, mostly Gram-negative bacilli （57.55 %）. The leading isolates of Gram-negative bacteria were Pseudornonas aeruginosa, Acinetobacter baumannii and Escherichia coli, accounting for 14.66%, 10.0% and 9.37 %, respectively. In addition, 277 strains of fungi and 116 strains of methicillin resistant Staphylococcus aureus （MRSA） were also been isolated as the main pathogens. Multivariate analysis showed that male, age.~.≥65y, long hospitalization （≥30 d） and the admit to intensive care unit were independent risk factors for HAIs. CONCLUSIONS The most frequent HAIs is lower respiratory infection, targeted surveillance to detect HAIs and intervention for preventing lower respiratory tract of infection should be enhanced.