院内感染病原菌变化趋势及耐药性分析

Drug Resistance of Pathogens for Nosocomial Infections

目的分析珠海香洲区院内感染病原菌变化趋势及耐药性,为制定预防措施提供依据。方法搜集2014年1月-2015年12月广东省珠海市香洲区医院以及社区医院院内感染患者的临床资料,记录所有患者的医院感染率、感染部位、病原菌分布以及耐药性,分析出现医院感染的危险因素。结果 2014年1月-2015年12月临床共分离1 250株病原菌,其中革兰阴性菌感染985例,占78.8%,革兰阳性菌感染220例,占17.6%,真菌感染45例,占3.6%;感染部位以呼吸道感染为主,共856例,占68.5%,其中上呼吸道感染184例,下呼吸道感染672例,分别占21.5%和78.5%;其次包括泌尿道、胃肠道、皮肤软组织和口腔感染,分别占13.8%、8.5%、5.2%和4.0%。医院感染的主要危险因素包括年龄、基础疾病、住院时间、意识障碍、滥用抗菌药物、留置导尿管、留置胃管和机械通气,其中年龄、住院时间、意识障碍、滥用抗菌药物和机械通气患者的医院感染率显著升高,差异有统计学意义(P<0.05)。结论医院感染的主要病原菌为革兰阴性菌,且以下呼吸道感染为主。此外,感染的发生可能与年龄、住院时间、意识障碍、滥用抗菌药物和机械通气等危险因素有关。

Objective To analyze the changes and drug resistance of pathogens for nosocomial infections in hospitals in Xiangzhou District of Zhuhai so as to provide guidance for working out precautionary measures. Methods The clinical da- ta of patients with nosocomial infection in the hospitals and community hospitals from January 2014 to December 2015 were collected and nosocomial infection rate, site of infection, pathogen distribution and drug resistance of all patients were recor- ded. Risk factors of nosocomial infection were analyzed. Results From January 2014 to December 2015, 1,250 strains of pathogenic bacteria were clinically isolated, of which the case of gram - negative bacterial infection was 985 （78. 8% ）, gram - positive bacterial infection was 220 （ 17.6% ） and fungal infection was 45 （3.6%） ; 856 cases （68.5%） of infection oc- curred in respiratory tract, of which 184 cases were the upper respiratory tract infection, and 672 cases were the lower respir- atory tract infection, accounting for 21.5 % and 78.5 % respectively, followed by urinary tract, gastrointestinal tract, skin and soft tissue and oral infection, accounting for 13.8% , 8.5% , 5.2% and 4. 0% respectively. The main risk factors of nosocomial infection included age, underlying diseases, hospital stay, disturbance of consciousness, abuse of antibacterial drugs, indwelling catheter, indwelling gastric tube and mechanical ventilation, among which age, length of hospital stay, dis- turbance of consciousness, abuse of antibacterial drugs and mechanical ventilation led to an increasingly high nosocomial in- fection rate. The differences had statistical significance （P 〈 0. 05 ）. Conclusion The main pathogen of nosocomial infection is gram - negative bacteria, mainly causing respiratory tract infections. In addition, factors of infection may be related to age, length of stay, consciousness disturbance, abuse of antibacterial drugs and mechanical ventilation.