8846例高龄患者医院感染分析研究

Analysis of 8846 cases of elderly patients with Nosocomial infection

目的分析某大型综合医院高龄住院患者医院感染现状,为预防和控制高龄患者医院感染提供科学依据。方法对2012年1月~2015年1月≥80岁高龄住院患者进行前瞻性监测,建立医院感染患者数据库,并进行统计分析。结果2012~2015年共监测住院患者8846例,总住院天数为165258天,发生医院感染944例、1454例次,医院感染率为10.67%、例次感染率为16.44%,日医院感染率5.71‰,日感染例次率8.80‰;医院感染率较高的前几位科室是外科ICU、神经内科、康复医学病区、呼吸内科、放射治疗科、神经外科、肾病科、血液科、肿瘤科;感染部位以呼吸系统为主,占49.66%,其次为泌尿系统,占24.62%,血液系统占14.79%;导致感染的病原菌以革兰阴性菌为主,占59.54%,真菌和革兰阳性菌各占25.78%和14.68%。其中,呼吸系统病原菌主要以假单胞菌属、不动菌属为主,泌尿系统病原菌主要以念珠菌属、肠球菌和假单胞菌属为主,血液系统病原菌主要以葡萄球菌属为主。结论≥80岁高龄住院患者医院感染率较高,其医院感染防控工作应该作为医疗机构医院感染管理的重点内容,对重点部门、重点环节进行重点防控。

Objective To identify the nosocomial infection（NI） status of elderly inpatients in a large general hospital,and to provide scientific basis for the establishment of effective prevention and control measures. Methods From January 2012 to January2015, patients older than 80 were put under prospective surveillance and data of elderly patients with NI were collected for further statistical analysis. Results During 2012 to 2015,a total of 8846 inpatients were put under our surveillance,with 165258 accumulated hospitalization days;944 patients were infected in 1454 infection cases,with an infection rate of 10.67%,an infection cases rate of 16.44%,a day rate of infection of 5.71 ‰,and a day rate of infection cases of 8.80 ‰. The surgical ICU ward,the department of respiratory medicine,neurology,rehabilitation medicine,radiation therapy,nerve surgery,nephrology,hematology and oncology had higher NI rate than other departments. Respiratory infection（49.66%） was the most predominant infection type,followed by urinary system infection（24.62%） and bloodstream infection（14.79%）. Gram-negative bacteria（59.54%） were the most common pathogen, followed by fungus（25.78%）,Gram-positive bacteria（14.68%）. Pseudomonas and acinetobacter were the most predominant causes of respiratory infection;candida,enterococcus and pseudomonas genus were the most common causes of urinary infection and staphylococcus was the main cause of bloodstream infection. Conclusion Elderly inpatients older than 80 have higher NI infection rate and should be the focus of infection control measures.