2018—2022年乌鲁木齐某三甲肿瘤专科医院病房医院感染发生及病原菌分析

Analysis of nosocomial infection and pathogenic bacteria in a tertiary cancer hospital in Urumqi,2018-2022

目的分析2018—2022年乌鲁木齐市某三甲肿瘤专科医院病房医院感染发生及病原菌特征情况。方法通过医院感染实时监控系统获取2018年1月至2022年12月入住时长≥2 d的乌鲁木齐市某三甲肿瘤专科病房患者住院期间感染发生情况,并采用描述性分析方法对院内感染发生及病原菌特征情况进行分析。结果2018—2022年某三甲肿瘤专科病房总住院病例6647例,发生院感803例,发生率为12.08%;2021年、2022年的院感发生率均低于2018年、2019年、2020年(P<0.05);不同年份间院感发生率呈下降趋势(P<0.01)。803例医院感染患者共检出1067株病原菌,单病原菌感染635例,双重感染160例,多重感染8例。年龄、感染部位、恶性肿瘤、放化疗、抗菌药物使用种类、合并糖尿病、营养风险、侵入性操作、住院时间不同的医院感染患者病原菌检出率差异有统计学意义(P<0.05或P<0.01)。1067株病原菌中革兰阴性菌597株,占55.95%;革兰阳性菌320株,占22.99%;真菌150株,占14.06%。前5位病原菌依次为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、草绿色链球菌。大肠埃希菌对左氧氟沙星100.00%耐药率,其次为氨苄西林和头孢呋辛酯,耐药率分别为97.46%和65.68%;铜绿假单胞菌对氨苄西林100.00%耐药率,其次为头孢呋辛酯和头孢替坦,耐药率分别为98.57%和97.86%。金黄色葡萄球菌对青霉素90.60%耐药,其次为红霉素和克林霉素,耐药率分别为48.72%和41.88%。结论该三甲肿瘤专科医院病房医院感染率有所下降,病原菌以革兰阴性菌为主,其分布具有明显的年龄、感染部位特征,建议制定针对性的预防措施,以控制医院感染的发生。

Objective To analyze the incidence of nosocomial infection and characteristics of pathogenic bacteria in a tertiary cancer hospital in Urumqi from 2018 to 2022.Methods The real-time monitoring system for nosocomial infection was used to obtain the incidence of infection during hospitalization of patients in a tertiary cancer hospital who stayed for≥2 days from January 2018 to December 2022.The descriptive analysis method was used to analyze the incidence of nosocomial infection and the characteristics of pathogenic bacteria.Results From 2018 to 2022,a total of 6647cases were hospitalized in a tertiary cancer hospital,and 803 cases of nosocomial infection occurred,with an incidence of12.08%.The incidence of nosocomial infection in 2021 and 2022 was lower than that in 2018,2019,and 2020(P<0.05).The incidence of nosocomial infection in different years showed a downward trend(P<0.01).A total of 1067strains of pathogens were detected in 803 patients with nosocomial infection,including 635 cases of single pathogen infection,160 cases of double infection,and 8 cases of multiple infection.There were statistically significant differences in the detection rate of pathogenic bacteria in patients with nosocomial infection in terms of age,infection site,malignant tumor,radiotherapy and chemotherapy,types of antibiotics used,diabetes mellitus,nutritional risk,invasive operation,and hospitalization time(P<0.05 or P<0.01).Among 1067 strains of pathogenic bacteria,597 strains were Gram-negative,accounting for 55.95%,320 strains were Gram-positive,accounting for 22.99%,and 150 strains were fungi,accounting for 14.06%.The top five pathogens were Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus,Klebsiella pneumoniae,and Streptococcus viridans.The resistance rates of Escherichia coli to levofloxacin,ampicillin,and cefuroxime axetil were 100.00%,97.46%,and 65.68%,respectively.The resistance rate of Pseudomonas aeruginosa to ampicillin was 100.00%,followed by cefuroxime axetil and cefotetan,with resistance rates of 98.57% and 97.86%,respectively.The resistance rates of Staphylococcus aureus to penicillin,erythromycin,and clindamycin were 90.60%,48.72%,and 41.88%,respectively.Conclusions The incidence of nosocomial infection in the tertiary cancer hospital decreased year by year.The pathogens were mainly gram-negative bacteria,and their distribution had obvious characteristics of age and infection site.It is suggested to formulate targeted preventive measures to control the occurrence of nosocomial infection.