某院住院患者感染及抗菌药物使用横断面调查

Cross-sectional survey on infection and antimicrobial application in patients in a hospital

目的调查某院住院患者医院感染现患率及社区感染情况,为医院感染防控提供依据。方法采用床旁调查与查阅病历相结合的方法,调查2011年9月26日0∶00—24∶00该院所有住院患者。结果应调查住院患者1 331例,实际调查1 309例,实查率为98.35%。发现感染患者237例,其中医院感染57例(4.35%),60例次(4.58%);社区感染181例(13.83%),183例次(13.98%);同时存在医院和社区感染者1例。医院感染部位居前3位的是下呼吸道(48.33%)、器官腔隙(16.67%)和泌尿道(8.33%)。社区感染率居前3位的科室分别为:呼吸科(84.44%)、儿科(71.43%)、重症监护室(50.00%);感染部位以下呼吸道(45.36%)和皮肤软组织(15.30%)多见。共分离病原体65株,其中医院感染33株,社区感染32株;其中铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌合计分别占医院感染和社区感染的72.73%(24/33)、78.13%(25/32)。抗菌药物日使用率为27.43%(359例),其中预防用药占52.92%,治疗用药占43.45%,预防+治疗用药占3.62%;以单一用药为主,占88.02%,二联用药占11.98%。病原学送检率为61.54%(104/169)。结论感染现患率调查有助于全面了解医院感染及社区感染现状和抗菌药物使用情况,有利于针对性地开展监测。

Objective To investigate the point prevalence of healthcare-associated infection（HAD and community- associated infection （CAD in patients in a hospital, so as to provide basis for the prevention and control of HAL Methods By combination of bedside survey and medical record reviewing, all patients who were hospitalized be- tween 0：00 and 24：00 o＇clock of September 26, 2011were investigated. Results 1 331 patients should be surveyed, 1309 （98. 35%） were actually surveyed. 237 patients were infected, 57 （4. 35 % ） of whom developed 60 episodes （4. 58%） of HAI ; 181 （13. 83%） of whom developed 183 episodes （13.98%） of CAI; 1 patient developed both HAI and CAI. The top three infection sites of HAI were lower respiratory tract（48. 33%）, organ space （16. 67%） and urinary tract （8.33%）. CAI were common in the following three departments ： department of respiration medi- cine（84. 44%）, pediatric department（71.43%） and intensive care unit（50. 00%）;the main infection sites of CAI were lower respiratory tract（45.36%） and skin and soft tissue（15. 300/oo）. A total of 65 pathogenic strains were iso- lated, 33 of which were HAI isolates and 32 were CAI isolates; Pseudomonas aeruginosa, Acinetobacter bauman- nil, Escherichia coli and KlebsielZa pneumoniae altogether accounted for 72. 73% （24/33） of HAI and 78. 13% （25/ 32）of CAI. The daily antimicrobial usage rate was 27. 43% （359 cases）, 52. 92% of which were for prophylactic use, 43. 45% for therapeutic use, and 3.62% for both prophylactic and therapeutic use; 88. 020/oo of antimicrobial application were single dose, and 11. 98% were the combination of two agents. Pathogen detection rate was 61.54%（104/169）. Conclusion Survey of point prevalence of infection is helpful to the realizing of the current state of HA1 and CAI and application of antimicrobial agents, and is beneficial to the target surveillance of infection.