唐山市37所医院医院感染与社区感染横断面调查分析

Healthcare-associated infection and community-acquired infection: Cross-sectional survey of 37 hospitals in Tangshan

目的了解唐山市37所医院住院患者医院感染和社区感染的实际状况及危险因素,为医院感染预防控制工作提供指导和依据。方法采取横断面调查的方法,对唐山市37所医院住院患者医院感染和社区感染现患率进行了调查与分析。结果调查当日从实查的16 650例患者中,共查出二、三级医院医院感染患者分别为171、267例,医院感染现患率分别为1.54%、5.24%;社区感染患者分别为1 889、831例,社区感染现患率分别为17.04%、16.31%。三级医院感染现患率高于二级医院,差异有统计学意义,而社区感染现患率差异无统计学意义。不同级别医院感染的部位差异有统计学意义,而社区感染的部位差异无统计学意义。共检出148株医院感染病原体,以铜绿假单胞菌、大肠埃希菌、克雷伯菌属、不动杆菌属居前4位;多重耐药菌检出率分别为26.32%、31.82%。二级、三级医院抗菌药物使用率分别为42.97%、34.88%。治疗性抗菌药物病原菌送检率分别为32.76%、47.10%,差异有统计学意义。本次调查发现血管内置管、泌尿道置管、呼吸机及免疫抑制剂的使用为医院感染的危险因素。结论医院应加强医院感染监测,提高病原体送检率,加强抗菌药物合理使用,采取多种防控措施控制医院感染现患率。

Objective To understand the status and the risk factors of healthcare-associated infection (HAI)and community-acquired infection(CAI),and to provide guidance and basis for prevention and control of nosocomial infections. Methods We investigated and analyzed HAI and CAI of 37 hospitals by the cross-sectional survey method. Results 16 650 patients were investigated,the HAI occurred in 171 and 267 cases with the prevalence rate of 1.54% and 5.24% in the second-class and the third-class hospitals. The CAI occurred in 1 889 and 831 cases with the prevalence rate of 17.04% and 16.31%. HAI prevalence rate in the third-class hospitals was higher than the second-class hospitals,while there was no difference in the rate of CAI. There was statistical significance in constituent of infection sites in different levels of hospitals. There was no difference in community infection. A total of 148 pathogens were isolated from patients with HAI,and the top four bacteria were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumonia,Acinetobacter baumannii. The detection rate of multidrug-resistant bacteria were 26.32% and 31.82% respectively in the second-class and the third-class hospitals. The utilization rates of antimicrobial agents in the second-class and the third-class hospitals were 42.97% and 31.82% respectively. Pathogen detection rate in third-class hospitals was higher than that of the second-class hospitals(47.10%, 32.76%),and the difference was statistically significant. The survey was found that the use of catheters,urinary tract catheters,ventilators and immunosuppressive agents were risk factors in hospital infection. Conclusion Hospitals should strengthen the monitoring of hospital infection and take various measures to control the rate of hospital infection.