新冠疫情期间住院患儿院内感染及多重耐药菌变化趋势分析

Analysis of Nosocomial Infection Surveillance and Multi-drug Resistant Organisms in Inpatient Children before and after the COVID-19 Pandemic

目的:回顾性分析新冠疫情对住院患儿院内感染产生的影响以及多重耐药菌的变化。方法:收集2017年至2022年的医院感染监测数据,包括重点关注部位和科室、器械相关性感染和多重耐药菌数据。对新冠疫情前和疫情期间的数据进行比较和分析。结果:共收集疫情前185116名和疫情期间218681名住院患儿的数据。与疫情前相比,疫情期间患儿平均住院天数从6.5天下降至6.1天,NICU、ICU和SICU的平均住院天数增加。住院患儿的感染率从2.7%降至1.79%,呼吸机的使用率从0.9%增加至1.3%,VAP感染率从6.08‰降至2.55‰,中央血管导管使用率从3.42‰增加至13.97‰,均差异显著(P<0.001),CLABSI、住院患儿导尿管的使用率、CAUTI无统计学差异。除ICU多重耐药菌检出率从30%增加至42%,全院多重耐药菌检出率无统计学差异。检出MRSA与CRE占比下降,CRAB与CRPA占比增加。结论:疫情期间各种阻断病毒传播的防控措施使全院住院患儿感染率下降,设备相关的VAP感染率显著降低。医院应继续加强院内感染控制措施,预防可能增加的多重耐药菌的发生。

Objective:This article reviews the impact of the COVID-19 pandemic on the nosocomial infections and the changes in multidrug-resistant among inpatient children through a retrospective analysis.Methods:Hospital infection surveillance data before and after the COVID-19 pandemic from 2017 to 2022 were collected,including data on key departments and sites,device-associated infections,and multidrug-resistant bacteria.The data before and after the pandemic were compared and analyzed.Results:A total of 185,116 and 218,681 sets of data were collected before and during the pandemic,respectively.During the pandemic,the average length of stay for all hospitalized patients decreased from 6.5 days to 6.1 days,while the average length of stay for NICU,ICU,and SICU patients increased.The infection rate among hospitalized children decreased(from 2.7% to 1.79%),while the use of mechanical ventilation increased(from 0.9% to 1.3%),and the incidence of VAP decreased significantly from 6.08‰ to 2.55‰.The use of central venous catheters increased significantly from 3.42‰ to 13.97‰.The difference is significant,P<0.001.There was no statistically significant difference in CLABSI compared to before the pandemic.There was no statistically significant difference in the use of indwelling urinary catheters and the incidence of CAUTI before and after the pandemic.Except for an increase in the detection rate of multidrug-resistant bacteria in ICU patients from 30% to 42%,there was no statistically significant difference in the detection rate of multidrug-resistant bacteria before and after the pandemic.The proportion of MRSA and CRE decreased,while the proportion of CRAB and CRPA increased.Conclusion:This study shows that various COVID-19 prevention and control measures during the pandemic have reduced the infection rate among hospitalized children and significantly reduced the incidence of device-related VAP infections.Hospitals should continue to strengthen infection control measures and prevent the occurrence of possible multidrug-resistant bacteria.