湖北省47所医院连续4年ICU医院感染目标性监测分析

Targeted surveillance of nosocomial infection in ICUs of 47 hospitals of Hubei Province in 4 consecutive years

目的了解湖北省重症监护病房(ICU)医院感染和器械相关感染情况,为医院感染管理提供方法学依据。方法采用前瞻性调查方法对湖北省47所医院2012年-2015年入住ICU的患者进行医院感染目标性监测,对ICU患者医院感染发病率、医院感染部位分布、器械相关感染发病率、病原菌分布情况等进行统计学分析。结果共监测126946例患者,医院感染发病率为5.51%,连续4年ICU医院感染发病率呈逐年下降趋势(P<0.001)。医院感染部位以下呼吸道为主,占77.27%。呼吸机相关性肺炎(VAP)、导管相关性血流感染(CRBSI)、导尿管相关性尿路感染(CAUTI)的发病率分别是21.07‰、1.45‰、1.15‰,与2012年相比,2015年VAP和CRBSI发病率均下降,且差异有统计学意义(P<0.05)。共分离出8921株病原菌,以革兰阴性菌为主(72.95%)。排名居前五位的病原体分别是鲍氏不动杆菌(24.91%)、铜绿假单胞菌(13.75%)、肺炎克雷伯菌(11.96%)、金黄色葡萄球菌(10.92%)、大肠埃希菌(8.23%)。结论该省ICU医院感染发病率呈明显下降趋势,院感防控工作取得一定成效。器械相关感染以VAP发病率最高,是ICU医院感染管理的重中之重。

OBJECTIVE To understand the prevalence of nosocomial infection and device-associated infection in intensive care unit(ICU)in Hubei province so as to provide scientific basis for control of nosocomial infection.METHODS By means of prospective survey,the targeted surveillance of nosocomial infection was carried out for the patients who were hospitalized in ICUs of 47 hospitals in Hubei province from 2012 to 2015.The incidence of nosocomial infection,distribution of nosocomial infection sites,incidence of device-associated infection and distribution of pathogens were statistically analyzed.RESULTS Of totally 126946 patients who were monitored,the incidence rate of nosocomial infection was 5.51%,and the incidence rate of nosocomial infection was decreased in the ICUs year by year in the 4 consecutive years(P<0.001).The patients who had lower respiratory tract infection were dominant among the patients with nosocomial infection,accounting for 77.27%.The incidence rates of ventilator-associated pneumonia(VAP),catheter-related bloodstream infection(CRBSI)and catheter-associated urinary tract infection(CAUTI)were 21.07‰,1.45‰and 1.15‰,respectively.The incidence rates of VAP and CRBSI were significantly lower in 2015 than in 2012(P<0.05).Totally 8921 strains of pathogens were isolated,72.95%of which were gram-negative bacteria.Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus and Escherichia coli ranked the top 5 species of pathogens,accounting for 24.91%,13.75%,11.96%,10.92%and 8.23%,respectively.CONCLUSION The incidence of nosocomial infection is significantly decreased in the ICUs of the province,indicating that it has made some achievements in control of the infection.The incidence of VAP is the highest among the device-associated infection,and it is necessary to focus on the control of VAP in the ICUs.