医院内菌血症发病率与病原体分析

Incidence and pathogens of nosocomial bacteremia in China

目的 了解医院内菌血症的发病率和病原体特点。方法 收集全国医院感染监控网医院 1998年 7月～ 2 0 0 1年 12月医院内菌血症的资料并进行统计分析。结果 监测 4882 36 4例患者 ,报告医院内菌血症 2 371例次 (占医院感染例次的 1 3% ) ,发病率为 48 6 /10万。菌血症发病率较高的有血液科、传染科、烧伤患者、Ⅲ类手术切口患者、儿科新生儿 ;肾病科、普通外科、胸心外科、肿瘤科患者发病率在增加。分离病原体 175 7株 ,G+菌 5 85株 ( 33 3% ) ,G-菌 96 2株 ( 5 4 7% ) ,真菌 186株( 10 6 % ) ,其他 2 4株 ( 1 4% )。常见病原菌为大肠埃希菌 ( 17 2 % ) ,凝固酶阴性葡萄球菌 ( 13 4% ) ,真菌 ( 10 6 % ) ,克雷伯菌属 ( 9 1% ) ,金黄色葡萄球菌 ( 8 1% ) ,铜绿假单胞菌 ( 6 8% ) ,肠杆菌属 ( 6 3% )。结论 医院内菌血症以血液科、传染科、烧伤科患者 ,Ⅲ类手术切口患者 ,儿科新生儿较高。病原体以G-菌为主 ,真菌占 10 6 % ,常见致病菌为大肠埃希菌、凝固酶阴性葡萄球菌、真菌、克雷伯菌属、金黄色葡萄菌、铜绿假单胞菌、肠杆菌属。

Objective To investigate the incidence and pathogens of nosocomial bacteremia (NB) in China. Methods The data of incidence and pathogens of NB reported from Jun 1998 to Dec 2001 by the hospitals of the Chinese nosocomial infections surveillance system (CNISS) were collected and analyzed. Results A total of 4 882 364 patients were surveyed and 2 371 cases of NB were reported. The incidence rate of NB was 48.6/100 000, accounting for 1.3% of nosocomial infection. The incidence of bacteremia was higher in units of hematology,infectious disease, neonatology, and burns, and among the surgical patients with contaminated wound. 1 757 strains of pathogens had been isolated, among which 585 (33.3%) were gram-positive bacteria, 962(54.8%) gram-negative bacteria, 186 (10.6%) fungi,and 24 (1.4%) other pathogens. The most common pathogens were Escherichia coli (17.2%), Coagulase negative staphylococcus (CoNS 13.4%), fungi (10.6%), Klebsiella (9.1%),Staphylococcus aureus (8.1%), Pseudomonas aeruginosa (6.8%), and Enterobactor (6.3%) spp. Conclusion Patients in unit of hematology, infectious diseases, burns and neonatology and surgical patients with class III incision have higher incidence of nosocomial bacteremia. Gram-negative bacteria were the prominent pathogens, the most common pathogens were E. coli, CoNS, fungi, Klebsiella, S. aureus, P. aeruginosa, and Enterobactor spp.