2017—2019年妇产科重症监护病房院内感染的特征分析

Analysis of characteristics of nosocomial infection in maternal intensive care unit from 2017 to 2019

目的分析2017—2019年妇产科重症监护病房(MICU)院内感染的特征,为产科管理服务新模式下院内感染的预防及控制工作提供参考。方法选取2017年1月1日至2019年12月31日西北妇女儿童医院MICU院内感染患者作为研究对象,对其特征进行分析。结果 4 681例患者中,发生院内感染61例,其中3例发生2次院内感染,共发生院内感染64次。2017—2019年院内感染发生率分别为1.02%、1.32%、1.51%,2017—2019年院内感染发生率比较,差异无统计学意义(P>0.05)。感染部位以生殖道为主,占40.62%,其次为血液系统,占26.56%;2017—2019年,生殖道、血液、尿管相关部位、盆腹腔、呼吸道、导管血流、皮肤感染例次占比比较,差异无统计学意义(P>0.05)。送检标本中导管阳性检出率最高,占61.11%,血阳性检出率最低,占30.91%;2017—2019年,血、生殖道分泌物、尿、引流液等体液、导管阳性检出率比较,差异无统计学意义(P>0.05)。病原菌以G^(+)菌为主,占56.67%,其中肠球菌占G^(+)菌的56.86%(29/51)、无乳链球菌占G^(+)菌的11.76%(6/51);2017—2019年,G^(+)菌、G^(-)菌、真菌的占比比较,差异无统计学意义(P>0.05)。多重耐药菌以产超广谱β-内酰胺酶(ESBLs)肠杆菌为主,占95.65%(22/23);2017—2019年,多重耐药菌占比比较,差异无统计学意义(P>0.05)。结论 2017—2019年MICU院内感染发生率无明显变化,以生殖道、血液系统感染相对突出,病原菌以G^(+)菌为主。MICU应加强生殖道感染的预防与治疗;患者发生感染后应加强对G^(+)菌的监测,避免院内感染的暴发,有效降低院内感染发生率,最大程度保障患者的医疗安全。

Objective To analyze the characteristics of nosocomial infection in maternal intensive care unit(MICU) from2017 to 2019,and to provide reference for the prevention and control of nosocomial infection under the new mode of obstetric management service.Methods Patients with nosocomial infection in MICU of northwest women’s and children’s hospital from January 1,2017 to December 31,2019 were selected as the research objects,and their characteristics were analyzed.Results Among 4 681 patients,61 cases had nosocomial infection,of which 3 cases had nosocomial infection twice,with a total of 64 times.From 2017 to 2019,the incidence of nosocomial infection was 1.02%,1.32% and 1.51%respectively,there was no significant difference in the incidence of nosocomial infection from 2017 to 2019(P>0.05).The infection site was mainly reproductive tract,accounting for 40.62%,followed by blood system,accounting for 26.56%;from 2017 to 2019,there were no significant differences in the proportion of cases of reproductive tract,blood,catheterrelated site,pelvic and abdominal cavity,respiratory tract,catheter blood flow and skin infection(P >0.05).In the submitted sample,the positive detection rate of catheter was the highest,accounting for 61.11%,and the positive detection rate of blood was the lowest,accounting for 30.91%;from 2017 to 2019,there were no significant differences in the positive detection rate of blood,reproductive tract secretion,body fluids such as urine and drainage,catheter(P>0.05).The pathogen was mainly G^(+)bacteria,accounting for 56.67%,of which Enterococcus accounted for 56.86%(29/51) and Streptococcus agalactiae accounted for 11.76%(6/51);from 2017 to 2019,there were no significant differences in the proportion of G^(+)bacteria,G^(-)bacteria and fungi(P >0.05).Multidrug resistant bacteria was mainly extended-spectrum beta-lactamases(ESBLs) Enterobacter,accounted for 95.65%(22/23);from 2017 to 2019,there was no significant difference in the proportion of multidrug resistant bacteria(P >0.05).Conclusion There is no significant change in the incidence of nosocomial infection in MICU from 2017 to 2019.Reproductive tract and blood system infection are relatively prominent,and the pathogen is mainly G^(+)bacteria.MICU should strengthen the prevention and treatment of reproductive tract infection;after infection,the monitoring of G^(+)bacteria should be strengthened to avid the outbreak of nosocomial infection,effectively reduce the incidence of nosocomial infection and ensure the medical safety of patients to the greatest.