福建省116所医院医院感染与社区感染现患率调查

Prevalence survey on nosocomial infection and community-acquired infection in 116 hospitals in Fujian Province

目的了解福建省医院感染与社区感染患病率及抗菌药物使用情况,为全省开展目标性监测提供依据。方法采用查阅住院患者病历与床旁调查相结合的方法,调查全省116所二级及以上医院住院患者的日医院感染与社区感染现患率及抗菌药物日使用情况,并对数据进行统计分析。结果共收到116份汇总表,其中合格113份(97.41%),实际调查住院患者48947例。发现医院感染患者1595例(3.26%),1739例次(3.55%);社区感染患者9 751例(19.92%),10062例次(22.56%)。感染部位以下呼吸道为主,在医院感染中占49.34%,社区感染中占45.70%。感染病原体以革兰阴性杆菌为主,其中医院感染以铜绿假单胞菌居首位,占15.05%;社区感染以大肠埃希菌居首位,占8.90%。医院感染现患率较高的科室:综合重症监护室38.22%(99/259),血液病科12.54%(85/678),神经外科9.44%(152/1611);社区感染现患率较高的科室:儿科非新生儿组82.02%(2053/2503),呼吸科70.46%(1577/2238),儿科新生儿组52.23%(409/783)。抗菌药物日使用率为38.28%(18738/48 947),治疗用药病原学送检率为42.68%(4735/11093)。结论应重点监测医院感染高发科室,提高病原学送检率,加强对多重耐药菌的监测和抗菌药物合理应用的管理,以有效预防与控制医院感染。

Objective To understand the status of nosocomial infection （NI） and community-acquired infection （CAD and antimicrobial use in Fujian Province, and provide the evidence for targeted monitoring. Methods All inpatients in 116 hospitals were requested to make a prevalence survey of NI and CAI and antimicrobial use by bedside visiting and patients＇ medical records checking, and data were analysed statiscally. Results A total of 116 surveyed data were collected, 113 （97. 41%） of which were qualified , 48 947 patients were actually investigated. 1595 （3.26%） patients developed 1 739 cases（3. 55%） of NI ; 9 751 （19. 92%） patients developed 10 062 cases （22. 56%） of CAI. The major infection site was lower respiratory tract, which accounting for 49. 34% of NI, and 45.70% of CAl. Gram-negative bacilli were the major pathogens , and Pseudomonas aeruginosa was the most corn mon pathogen（ 15.05 %） in NI, Escherichia coli was the major pathogen in CAI （8. 90%）. The departments with high NI prevalence rates were general intensive care unit （38. 22%, 99/259）, hematological unit （ 12. 54%, 85/ 678）, and neurosurgical unit（9. 44%, 152/1 611）; the department with high CAI prevalence were non neonatal group of pediatric unit （82.02% 2 053/2 503）, respiratory unit（70. 46%, 1 577/2 238）, neonatal group in pediatric unit（52. 23%, 409/783）. The daily usage rate of antimicrobial agents was 38.28% （18 738/48 947）, and pathogen detection rate in patients with curative antimicrobial use was 42.68% （4 735/1 1093）. Conclusion The management of departments with high NI rate should be strengthened , pathogen detection rate should be enhanced, moni tor on multidrug-resistant pathogens and management of antimicrobial agents should be intensified.