2006-2011年泌尿外科住院患者医院感染及多药耐药菌感染趋势分析

Nosocomial infections in hospitalized patients of urology department and trend of multidrug-resistant bacteria infections from 2006 to 2011

目的了解2006-2011年泌尿外科住院患者医院感染及多药耐药菌(MDROs)感染率、分布特点及变化趋势,以改进医院感染预防控制措施。方法对2006-2011年入住泌尿外科21 508例患者及金黄色葡萄球菌、肠球菌属、大肠埃希菌、肺炎克雷伯菌和鲍氏不动杆菌培养阳性的患者进行前瞻性调查,调查医院感染及多药耐药菌感染情况。结果 6年内泌尿外科21 508例住院患者中发生医院感染125例,感染率为0.58%;感染部位主要为泌尿道、手术部位和菌(败)血症,分别占39.71%、23.53%、20.59%;共检出病原菌115株,以大肠埃希菌最多占50.43%;检出的金黄色葡萄球菌、肠球菌属、大肠埃希菌、肺炎克雷伯菌和鲍氏不动杆菌84株主要病原菌中检出多药耐药菌55株,检出率为65.48%,以产ESBLs大肠埃希菌检出率最高,占83.64%;通过采取控制措施,2009年产ESBLs大肠埃希菌医院感染率较2006年明显下降(RR=0.28,95%CI:0.05～1.06,P=0.04),控制效果较好。结论泌尿外科住院患者医院感染预防控制的重点为泌尿道感染,在病原菌中需关注大肠埃希菌,尤其是产ESBLs大肠埃希菌。

OBJECTIVE To understand the status of nosocomial infections in hospitalized patients of urology department, the incidence of mutldrug-resistant bacteria infections, distribution, and change trend from 2006 to 2011 so as to improve the prevention and control measures. METHODS A total of 21 508 patients who were hospitalized the urology department from 2006 to 2012 were enrolled in the study, then the prospective surgery was conducted for the patients who were cultured positive for Staphylococcus aureus, Enterococcus, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, and the incidence of nosoeomial infections and the multidrug-resistant bacteria infections was observed. RESULTS Of totally 21 508 cases of hospitalized patients of urology department investigated within 6 years, the nosocomial infections occurred in 125 cases with the incidence rate of 0.58O/oo, among which the patients with urinary tract infections accounted for 39.71 ~//0, the patients with surgical sites infections 23. 53%, the patients with bloodstream infections 20. 59%. Totally 115 strains of pathogens were isolated, among which the E. coli was the predominant species , accounting for 50. 43~//00~ 55 strains of multidrug-resistant bacteria were detected among the 84 strains of S. aureus, Enterococcus, E. coli, K. pneumoniae, and A. baurnannii with the detection rate of 65. 48~, with the detection rate of ESBLs- producing E. coli the highest （83.64~/0）. Through the implementation of control measures, the incidence rate of ESBLs-producing E. coli infections was significantly decreased in 2009, as compared with that in 2006 （RR= 0.28,95 CI：0.05-1.06,P〈0.04） , the control effect was good. CONCLUSIONS It is necessary to focus on the prevention of urinary tract infections in the hospitalized patients of urology department and attach great importance to the E. coli, ESBLs-producing E. coli in particular.