2014年新疆132所医院医院感染横断面流行病学调查

Epidemiological cross-sectional investigation on healthcare-associated infection of 132 hospitals in Xinjiang in 2014

目的了解新疆地区不同级别医院医院感染及社区感染现状。方法采用床旁调查与病历调查相结合的方法对2014年3月20日新疆二级及以上医院住院患者感染、抗菌药物使用情况及病原学监测信息进行横断面调查。结果实际调查132所医院66 208例住院患者,医院感染现患率1.83%,医院感染例次现患率2.02%;社区感染现患率24.53%,社区感染例次现患率24.83%。三级医院的医院感染现患率(2.58%)高于二级医院(1.44%),而社区感染现患率(17.84%)低于二级医院(28.01%),差异均有统计学意义(均P<0.001)。科室分布中重症监护病房(ICU)医院感染现患率(14.91%)最高,社区感染中儿科组感染率较高。呼吸道、手术部位和泌尿道为医院感染常见部位。抗菌药物使用率为31.27%,二级医院抗菌药物使用率(35.95%,15 642例)高于三级医院(22.32%,5 064例),三级医院治疗性使用抗菌药物病原菌送检率(59.40%,2 224例)高于二级医院(53.59%,6 436例),差异均有统计学意义(χ2值分别为1 288.974、38.964,均P<0.001)。医院感染病原菌以革兰阴性杆菌为主,前3位依次为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌。结论横断面调查结果能较好地反映新疆不同级别医院的感染现状,提示需加强感染目标微生物的监测与抗菌药物合理使用的管理和评价,关注重点人群及重点部位感染风险管理。

Objective To investigate current status of healthcare-associated infection（HAI）and community-associated infection（CAI）of different levels of hospitals in Xinjiang.Methods Infection,antimicrobial use and pathogen detection in patients in second-class and above hospitals in Xinjiang on March20,2014 were performed cross-sectional survey by bedside visiting and medical record reviewing methods.Results A total of 66 208 patients in132 hospitals were investigated,HAI prevalence rate and case prevalence rate was 1.83% and 2.02%respectively;CAI prevalence rate and case prevalence rate was 24.53% and 24.83%respectively.HAI prevalence rate in third-class hospitals was higher than second-class hospitals（2.58% vs 1.44%,P〈0.001）,while CAI prevalence rate was lower than second-class hospitals（17.84%vs 28.01%,P〈0.001）.HAI prevalence rate was highest in intensive care unit（14.91%）,CAI was highest in pediatric department.The common infection sites were respiratory tract,surgical site and urinary tract.Antimicrobial usage rate was 31.27%,antimicrobial usage rate in second-class hospitals was higher than that of the third-class hospitals（[35.95%,n=15 642]vs[22.32%,n=5 064],χ^2=1 288.974,P〈0.001）,pathogen detection rate in third-class hospitals was higher than that of the second-class hospitals（[59.40%,n=2 224]vs[53.59%,n=6 436],χ^2=38.964,P〈0.001）Gram-negative bacilli were main isolated pathogens,the top 3 pathogens were Escherichia coli,Klebsiella pneumoniae,and Acinetobacter baumannii.Conclusion The cross-sectional survey can reflect infection status of different levels of hospitals,surveillance of targeted microbial detection and rational antimicrobial use should be strengthened,management of infection in high risk population and key sites should be paid close attention.