全国医院感染监控网医院感染病原菌分布及变化趋势

Distribution of pathogens causing nosocomial infection monitored by national nosocomial infection surveillance system and changing trend

目的探讨医院感染病原菌分布及变化趋势。方法对1999年1月-2007年12月全国医院感染监控网各监测医院报告的病原体进行统计分析。结果共分离出医院感染病原体59 985株,其中革兰阴性菌、革兰阳性菌和真菌分别占48.86%、26.21%、24.21%;在各感染部位分离的病原体中,除胃肠道以真菌为主、血管导管相关以革兰阳性菌为主外,其他均以革兰阴性菌为主,占40.31%～59.00%;在所有病原体中占首位的为白色假丝酵母菌,其次为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎克雷伯菌;下呼吸道感染居首位的病原体铜绿假单胞菌,泌尿道、血液和手术部位感染居首位的病原体为大肠埃希菌;在病原体构成中1999年1月-2001年12月(第1时段)革兰阴性菌、革兰阳性菌和真菌分别占47.21%、26.83%、25.13%,2005年1月-2007年12月(第3时段)分别占53.20%、23.70%和22.36%,2个时段相比差异有统计学意义;第3时段与第1时段相比增加最多的细菌是鲍氏不动杆菌,从3.89%上升至7.26%,其次为肺炎克雷伯菌、屎肠球菌,分别从5.75%、0.97%上升至8.14%和1.92%;减少最多的细菌是表皮葡萄球菌,从5.15%降至3.22%,其次是乙酸钙不动杆菌,从1.06%降至0.59%。结论医院感染病原体以革兰阴性菌为主,其次为革兰阳性菌和真菌,主要医院感染部位居首位的病原体各不相同;在病原体构成中革兰阴性菌呈上升趋势,革兰阳性菌和真菌呈下降趋势,且有向高度耐药菌集中的趋势。

OBJECTIVE To observe the pathogen distribution and changing trend of nosocomial infection（NI） in china monitored by China Nosocomial Infection Surveillance System（NICSS）.METHODS The pathogens reported by NICSS between Jan 1999 and Dec 2007 were statistically analyzed.RESULTS Among the isolated 59 985 strains of pathogens,the constituent ratio of Gram-negtive bacilli was 48.86%,Gram-positive bacterium was 26.21% and fungi was 24.21%.Among the isolated pathogens from infectious sites,except the gastrointestinal tract infection was mostly caused by fungi,catheter-related bloodstream infection was mostly caused by gram-positive bacteria,the other sites were mostly caused by Gram-negtive bacilli,accounting for 40.31%-59.00%.Among all the pathogens,the premier bacteria was Candida albicans,the followings were Escherichia coli,Pseudomonas aeruginosa,methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae.The premier pathogen isolated from the lower respiratory tract was PAE,urinary tract,blood and surgical sites was E.coli.The pathogenil constituent ratios of Gram-negtive bacilli,Gram-positive bacteria and fungi were 47.21%,26.83% and 25.13%,respectively,from Jan 1999 and Dec 2001（the first phase）,and from Jan 2005 to Dec 2007（the third phase）,the constituent ratios were 53.20%,23.70% and 22.36% respectively.There were statistically significant difference between the two phases.Compared to the first phase,the mostly increased bacterium in the third phase was Acinetobacter baumannii,which increased from 3.89% to 7.26%,and the followings were K.pneumoniae and Enterococcus faecium,which increasing from 5.75% to 8.14%,and 0.97% to 1.92%,respectively;The bacterium which decreased the most was Staphylococcus epidermidis,from 5.15% to 3.22%,the followings were Acinetobacter calcoacetius,which decreased from 1.06% to 0.59%.CONCLUSIONS The pathogens causing nosocomial infections monitored by NICSS are primarily Gram-negtive bacilli,the followings are Gram-positive bacteria and fungi.The main pathogens isolated from primary NI sites are different.The constituent ratio of Gram-negtive bacilli shows an upward tendency,while which of Gram-positive bacteria and fungi show downward tendency and highly concentrated trend for multiple drug resistence.