多药耐药菌医院感染流行病学特征与干预效果评价

Epidemiologic feature and evaluation of intervention effects on nosocomial infections of multidrug-resistant organisms

目的了解多药耐药菌(MDRO)医院感染情况,评价干预效果,为后期持续改进提供理论依据。方法回顾性调查医院2014年1月-2016年9月住院患者MDRO医院感染监测结果,分析MDRO医院感染流行病学特征,采取综合干预措施,2014年1月-2015年5月数据为干预前组,共调查患者102 692例;2015年6月-2016年9月为干预后组,共调查患者97 577例,比较两组患者MDRO感染率,评价干预效果。结果 2014年1月-2016年9月年共监测住院患者200 269例,共检出MDRO 1 552株,其中院内感染MDRO 449株,MDRO感染率为0.22%;不同性别、年龄患者感染率差异有统计学意义(P<0.05);院内感染MDRO致病菌前5位分别为鲍氏不动杆菌(45.66%)、金黄色葡萄球菌(17.82%)、铜绿假单胞菌(17.37%)、肺炎克雷伯菌(14.25%)和大肠埃希菌(2.45%);科室分布以ICU为主(46.32%),其次为外科、内科、新生儿与妇产科;季节分布呈现一、三季度高于二、四季度现象;通过采取综合性干预措施,MDRO感染株数由267株下降至182株,感染发生率由基线期0.26%下降至干预期0.19%,差异有统计学意义(P<0.05)。结论采取有针对性综合性干预措施,可有效降低多药耐药菌医院感染的风险,对保障医疗质量与安全具有重要意义。

OBJECTIVE To realize the status of nosocomial infections of multidrug-resistant organisms （MDRO） and evaluate the effects of interventions,so as to provide theoretical basis for continuous improvement.METHODS Retrospective investigation method was used to analyze the epidemiologic features of nosocomial infections of MDRO from Jan.2014 to Sep.2016.The data of 102 692 inpatients were used as pre-intervention group from Jan.2014 to May 2015,and the data of 97 577 inpatients were used as post-intervention group from Jun.2015 to Sep.2016.The Chi-squared test was used to compare the infection rates of MDRO of the two groups,and the effects of interventions were evaluated.RESULTS There were 200269 inpatients from Jan.2014 to Sep.2016,1552 strains of MDRO were detected while 449 strains were nosocomial infected,with the infection rate of 0.22%.The differences of infection rates between different genders and ages were significant（P〈0.05）.The top five pathogenic bacteria were Acinetobacter baumannii （45.66 %）,Staphylococcus aureus （17.82 %）,Pseudomonas aeruginosa （17.37 %）,K lebsiella pneumoniae （14.25 %）,and Escherichia coli （2.45 %）.Clinical distribution of nosocomial infections of MDRO were ICU（46.32%）,surgery department,internal medicine,neonatal department,and gynaecology and obstetrics.Seasonal distribution showed that infection rates of the first and third quarters exceeded the second and fourth.After taking comprehensive intervening measures,the detection of MDROs declined from 267 to 182,the infection rate declined from 0.26 % to 0.19%,and the differences were significant （P〈0.05）.CONCLUSION It is effective to reduce the risk of nosocomial infections of MDRO by taking comprehensive intervening measures and is very significance for guaranteeing quality and safety of medical care.