重症监护病房医院感染情况调查与分析

Prevalence of nosocomial infection in intensive care unit

目的分析重症监护病房患者发生医院感染和感染病原菌分布情况,为医院感染防控措施提供参考。方法对华中科技大学同济医学院附属同济医院综合重症监护病房(ICU)2016年-2017年住院治疗患者,进行临床资料回顾性分析,统计分析住院患者发生医院感染、导管相关感染及病原菌分布情况。结果共监测ICU住院患者2 151例,发生医院感染299例,感染率13.90%;2017年医院感染率为15.36%,高于2016年感染率12.17%,差异具有统计学意义(P=0.033)。感染主要以呼吸机相关性肺炎为主,感染率为7.25%;中心静脉导管相关性血流感染为0.51%;导尿管相关性尿路感染率为4.83%。共检出469株病原菌,其中,多药耐药菌占到65.25%,以碳青酶烯耐药鲍氏不动杆菌居首位;主要以痰液检出为主占到72.88%。结论综合ICU患者医院感染发生率较高,以呼吸机相关性肺炎为主,感染病原菌以多药耐药菌为主,应加强导管相关感染监测和多药耐药的防控,降低医院感染,保证患者安全。

OBJECTIVE To investigate the incidence of nosocomial infection in patients of intensive care unit(ICU) and analyze the distribution of pathogens causing the infection so as to provide guidance for prevention of the nosocomial infection. METHODS The clinical data of patients who were hospitalized in the ICUs of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2017 were retrospectively analyzed, and the incidence rates of nosocomial infection and catheter-related infection in the hospitalized patients and the species of isolated pathogens were statistically analyzed. RESULTS Of totally 2 151 hospitalized patients of ICU, 299 had nosocomial infection, with the infection rate 13.90%. The incidence rate of nosocomial infection was 15.36% in 2017, significantly higher than 12.17% in 2016(P=0.033). The patients with ventilator-associated pneumonia were dominant among the patients with nosocomial infection, and the infection rate was 7.25%. The incidence rate of central venous catheter-related bloodstream infection was 0.51%, and the incidence rate of urinary catheter-related urinary tract infection was 4.83%. A total of 469 strains of pathogens were isolated, 65.25% of which were multidrug-resistant organisms, and carbapenem-resistant Acinetobacter baumannii ranked the first place. 72.88% of the pathogens were isolated from sputum specimens. CONCLUSION The incidence of nosocomial infection is relatively high among the patients in general ICU, the ventilator-associated pneumonia is dominant, and multidrug-resistant strains are the predominant pathogens causing the infection. It is necessary to strengthen the monitoring of catheter-related infection and control of multi-drug resistance and reduce the incidence of nosocomial infection so as to keep the patients safe.