新疆医科大学附属肿瘤医院重症监护病房医院感染目标性监测

Targeted monitoring of nosocomial infections in intensive care unit of Tumor Hospital Affiliated to Xinjiang Medical University

目的了解分析肿瘤专科医院重症监护病房(ICU)医院感染目标性监测结果及特点,为制定医院感染预防控制措施提供科学依据。方法对2013年1-12月入住ICU的患者进行目标性监测,采用患者平均病情严重程度评分(ASIS)调整法调整医院感染发病率,监测3种侵袭性操作相关感染及多重耐药菌分布情况。结果共监测住院患者443例,总住院2 483 d,发生医院感染52例,感染率为11.7%,日感染率为20.9‰,经ASIS调整后日感染率为6.3‰。感染诊断以呼吸系统感染最多,占55.7%,其次为泌尿系统;发生呼吸机相关性肺炎12.1‰,导管相关性血流感染0.9‰,导管相关性尿路感染4.1‰。共检出病原菌181株,其中革兰阴性杆菌135株(74.6%),革兰阳性球菌33株(18.2%),真菌13株(7.2%),检出多重耐药菌33株(18.2%)。结论 ICU是医院感染的高发科室,应开展目标性监测,合理使用抗生素,监测病原菌及其耐药性,对危险因素进行监控,制定切实有效科学的防控措施,减少医院感染的发生。

Objective To summarize the result of targeted surveillance and characteristics of nosocomial infections in intensive care unit（ICU）of a tumor hospital,so as to provide scientific basis for prevention and control of nosocomial infections.Methods Targeted monitoring was performed for the patients who were admitted to ICU from January 2013 to December 2013.The incidence of the nosocomial infections was adjusted by average severity of illness（ASIS）.Three types of invasive procedure-related infections were monitored.Multidrug-resistant hospital infections were also investigated.Results The 443 inpatients monitored had a total of 2 483 days of hospital stay.Nosocomial infection was identified in 52（11.7%）patients.The overall daily incidence of infection was 20.9‰.The ASIS-adjusted daily incidence was 6.3‰.Most of the nosocomial infections were respiratory system infections（55.7%）,followed by urinary tract infections（19.2‰）,ventilator associated pneumonia（12.1 ‰）,catheter-related bloodstream infections（0.9 ‰）,and catheter-associated urinary tract infections（4.1‰）.Of the 181 strains of pathogens identified,gram-negative bacteria accounted for 74.6%（135/181）,gram-positive bacteria 18.2%（33/181）,and fungi 7.2%（13/181）.Thirty-three（18.2%）of the isolates were multidrug-resistant.Conclusions ICU is an important source of nosocomial infections.It is necessary to carry out targeted surveillance,promote rational use of antimicrobial agents,and implement effective prevention and intervention measures in ICU.