上海市87所医院2012-2015年血培养标本送检调查分析

Submission of specimens for blood culture in 87 hospitals of Shanghai from 2012 to 2015

目的分析上海市87所医院2012-2015年血培养标本送检情况。方法上海市院内感染质控中心对市监测网87所医院每季度开展一次血培养送检调查,对该季度最后一个月第2周的前三天发热≥38.5℃的住院患者信息及血培养送检情况进行收集和分析,数据采用SPSS20.0软件进行录入和分析。结果 2012-2015年,上海市87所医院发热患者全年血培养送检率分别为50.4%,49.7%,53.5%,56.3%,呈逐年上升趋势(χ~2=55.131,P<0.001);发热时使用抗菌药物的血培养送检率分别为89.7%,89.1%,90.4%,87.8%;合并白细胞数>18.0×109/L患者的送检率为50.5%~59.4%,怀疑术后感染患者的送检率为35.8%~50.3%,怀疑肺部感染患者的送检率为64.9%~70.9%,留置深静脉导管超过5d患者送检率为57.2%~68.6%,怀疑其他部位感染患者送检率为60.0%~63.9%;血培养未送检理由以发热原因明确(非感染因素)、感染灶明确、患者拒绝为主,但仍有一半标本未注明未送检理由。结论上海市87所医院血培养标本送检率呈逐年上升趋势,伴有血流感染高危因素患者仍存在漏送和漏报现象,今后应采取针对性的规范和管理措施,提升血培养的送检率。

OBJECTIVE To investigate the submission of specimens for blood culture in 87 hospitals of Shanghai.METHODS A survey was conducted for the submission rates of specimens for blood culture in 87 hospitals under the city surveillance network of Shanghai Quality Control Center for Hospital-acquired Infection.The information and submission rates of blood culture specimens were collected from the hospitalized patients with fever（≥38.5℃）in the first three days of second week of the last month of the current season,and the statistical analysis was performed with the use of SPSS20.0 software.RESULTS The submission rate of specimens for blood culture of the87 hospitals was 50.4%in 2012,49.7%in 2013,53.5%in 2014,56.3%in 2015,showing an upward trend（χ2=5.131,P〈0.001）;the submission rate of blood culture specimens of the patients who had fever and were treated with antibiotics was 89.7% in 2012,89.1% in 2013,90.4% in 2014,87.8% in 2015.The submission rates of blood culture specimens of the patients with white blood cells counts more than 18.0×109/L ranged from 50.5%to 59.4%;the submission rates of blood culture specimens of the patients with suspected postoperative infection varied from 35.8%to 50.3%;the submission rates of blood culture specimens of the patients with suspected pulmonary infection ranged between 64.9% and 70.9%;the submission rates of blood culture specimens of the patients with the time of deep venous catheter indwelling more than 5 days ranged between 57.2% and 68.6%;the submission rates of blood culture specimens of the patients with suspected infection of other sites varied from 60%to 63.9%.The clear cause of fever（not the infection factor）,clear focus of infection and patients′rejection led to the failure of submission,however,half of the specimens remained unknown reasons for submission.CONCLUSIONThe submission rate of blood culture specimens shows an upward trend in the 87 hospitals of Shanghai,there are still missubmitted and misreported patients who are at high risk of bloodstream infection.It is necessary to take targeted,standardized management measures so as to raise the submission rate of the blood culture specimens.