某综合医院多重耐药菌感染状况与变化趋势

发布时间：2018-08-31 12:36

【摘要】：目的:通过对多重耐药菌(MDRO)感染病例的监测,及时发现MDRO感染和定植患者,分析MDRO感染现状和变化趋势,探讨其可能的原因,从而确定MDRO防控的重点人群,以便更好地控制MDRO的产生和传播。方法:自2013年至2016年,由院感专职人员和实验室工作人员每日通过医院实验室信息系统(LIS)发现住院患者中检出的MDRO菌株,剔除同一患者的重复标本。监测的MDRO有:多重耐药/泛耐药的鲍曼氏不动菌(MDR/PDR-AB)、甲氧西林耐药的金黄色葡萄球菌(MRSA)、多重耐药/泛耐药的铜绿假单胞菌(MDR/PDR-PA)、万古霉素耐药的肠球菌(VRE)、碳青霉烯类耐药的肠杆菌科细菌(CRE)。2013年,发现住院患者中检出MDRO菌株后,医院感染科工作人员仅使用电话作为唯一方式告知患者所在病房对相应的患者采取消毒和隔离措施,并且对病例进行监测,也就是使用统一设计的调查表对患者进行逐一记录和追踪,临床病房自行完成相关的消毒隔离。2014年、2015年、2016年除了监测MDRO病例外,还对此加以干预措施,主要包括消毒隔离的落实、手卫生执行情况的落实、加大MDRO知识的培训力度、加强重点环节管理、合理使用抗菌药物,并逐年进行“计划Plan-执行Do-检查Check-纠正Action”(PDCA)质量持续改进措施。采取描述性流行病学研究方法,对2013年、2014年、2015年、2016年四年的MDRO感染状况和变化趋势进行分析。结果:1.2013年至2016年共监测MDRO医院感染例数546例,四年总的MDRO医院感染例次日发病率为0.24‰,2013年至2016年依次为0.32‰、0.24‰、0.21‰、0.18‰,逐年下降,差异有统计学意义(2趋势c=25.829,P0.001)。四年共监测MDRO例数1273例,四年MDRO检出率为4.30%,2013年至2016年依次为4.84%、4.21%、4.12%、3.99%,逐年下降,差异有统计学意义(2趋势c=6.554,P0.05)。四年中MRSA、MDR/PDR-PA的检出率逐年下降(2趋势c=51.719、21.154,P均0.001),CRE的检出率逐年升高(2趋势c=59.346,P0.001),差异均有统计学意义。VRE和MDR/PDR-AB的检出率的差异无统计学意义(c2分别1.768、1.842,P均0.05)。2.2013至2016四年中的重症监护室(ICU)、干部科、烧伤科的MDRO医院感染例次日发病率逐年下降,差异具有统计学的意义(2趋势c分别为27.270、9.503、10.338,P均0.01)。神经外科、移植科、耳鼻喉科、骨科、血液科、肾内科、胸外科、其他科室的MDRO医院感染例次日发病率的差异无统计学意义(P0.05)。四年中MDRO例数和医院感染例数分布最多的科室为ICU,其次为移植科、神经外科等。移植科、神经外科的MDRO医院感染例数占检出例数的比例较高,妇产科、感染科、呼吸科、中西医结合科的比例较低。3.不同季度MDRO医院感染例次日发病率和检出率不同,第一季度最高,分别为0.36‰和4.46%,第四季度最低,分别为0.19‰和3.44%,差异均有统计学意义(c2=38.945、12.442,P均0.01)。第一季度MDRO医院感染例数占检出例数的比例最高,第四季度最低。4.四年中MDRO病例和医院感染病例的病原体构成主要以MDR/PDR-AB(35.27%和40.84%)和MRSA(40.14%和28.57%)为主。MSRA、MDR/PDR-PA例数和医院感染例数及构成比有所降低,CRE例数和医院感染例数及构成比有所升高。CRE医院感染病例占MDRO检出病例的比例最高,为69.23%,MRSA最低,为30.53%。5.MDRO医院感染系统主要为呼吸系统(71.25%),其次为消化系统(12.45%)、血液系统、泌尿系统等。MRSA的主要感染部位是呼吸系统、皮肤和软组织等;MDR/PDR-AB、MDR/PDR-PA、CRE的主要感染部位是呼吸系统、消化系统等;VRE的主要感染部位是消化系统、泌尿系统等。四年中,住院患者MDRO标本来源最多的为呼吸道,其次为皮肤分泌物、尿液等。6.四年中,洗手液消耗量分别为4.90、7.64、10.86、11.43ml/床日数,速干手消毒剂消耗量分别为1.77、3.97、7.39、9.41ml/床日数,擦手纸消耗量分别为2.36、5.42、9.31、10.54抽/床日数,消耗量均逐年升高。洗手液、速干手消毒剂、擦手纸的消耗量与MDRO医院感染例次日发病率呈负相关(相关系数r分别为-0.971、-0.953、-0.969,P均0.05)。结论:2013年至2016年MDRO医院感染例次日发病率和检出率逐年下降,可能与采取的包括落实消毒隔离措施、严格医务人员手卫生等一系列干预措施以及洗手液、速干手消毒剂和擦手纸消耗量逐年升高有关。应进一步对于高发科室、高发时间、重点人群、不同MDRO进行有针对性的防控。
[Abstract]:OBJECTIVE: To detect MDRO infection and colonization in time by monitoring the cases of MDRO infection, analyze the current status and trend of MDRO infection, and explore the possible causes, so as to identify the key population for MDRO prevention and control, so as to better control the production and spread of MDRO. METHODS: From 2013 to 2016, full-time staff and practitioners from hospital infection were selected. Laboratory staff found MDO strains in hospitalized patients daily through the Hospital Laboratory Information System (LIS) and removed duplicate samples from the same patient. The MDO monitored included multidrug/pan-drug resistant Acinetobacter baumannii (MDR/PDR-AB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug/pan-resistant Pseudomonas aeruginosa. MDR / PDR - PA, Vancomycin - resistant Enterococcus (VRE), Carbapenem - resistant Enterobacteriaceae (CRE). In 2013, after the detection of MDRO strains in hospitalized patients, hospital infection staff only used the telephone as the only way to inform the patient's ward to take disinfection and isolation measures against the corresponding patients, and to improve the case In addition to monitoring MDRO cases in 2014, 2015 and 2016, interventions were also taken, including implementation of disinfection and isolation, implementation of hand hygiene, and training of MDRO knowledge. Strengthen the management of key links, rationalize the use of antibiotics, and carry out the "Plan-Do-Check-Correct Action" (PDCA) quality continuous improvement measures year by year. Adopt descriptive epidemiological methods to analyze the MDRO infection status and change trend in 2013, 2014, 2015 and 2016. In 2016, 546 cases of MDRO nosocomial infection were monitored. The incidence of MDRO nosocomial infection in four years was 0.24, 0.24, 0.21, 0.18, decreasing year by year from 2013 to 2016. The difference was statistically significant (2 trends C = 25.829, P 0.001). In four years, 1273 cases of MDRO were monitored. The detection rate of MDRO in four years was 4.30%, from 2013 to 2016. The detection rates of MRSA, MDR/PDR-PA decreased year by year (2 trends C = 6.554, P 0.05). The detection rates of CRE increased year by year (2 trends C = 51.719, 21.154, P 0.001). There was no significant difference between the detection rates of VRE and MDR/PDR-AB. The incidence of nosocomial infection of MDRO in ICU, Cadre and Burn Departments declined year by year from 2013 to 2014. The difference was statistically significant (2 trends C were 27.270, 9.503, 10.338, P were 0.01). Neurosurgery, transplantation, otorhinolaryngology, orthopedics, hematology, renal diseases There was no significant difference in the incidence of MDRO nosocomial infections in the following day among the departments of transplantation, thoracic surgery and other departments (P 0.05). The ICU was the most common one in the four years, followed by transplantation and neurosurgery. The incidence and detection rate of MDRO nosocomial infection in the first quarter were 0.36 and 4.46%, respectively. The lowest in the fourth quarter was 0.19 and 3.44%, respectively. The difference was statistically significant (c2 = 38.945, 12.442, P 0.01). The number of MDRO nosocomial infection cases in the first quarter accounted for the detection rate. The proportion of MDRO cases and nosocomial infections was the highest, and the lowest in the fourth quarter.4.In the four years, the main pathogens were MDR/PDR-AB (35.27% and 40.84%) and MRSA (40.14% and 28.57%). The infection cases accounted for the highest proportion of MDRO cases, 69.23%, MRSA lowest, 30.53%. 5. MDRO nosocomial infection system was mainly respiratory system (71.25%), followed by digestive system (12.45%), blood system, urinary system, etc. MRSA main infection sites were respiratory system, skin and soft tissue; MDR / PDR - AB, MDR / PDR - PA, CRE main infection sites. The major infection sites of VRE were the digestive system and urinary system. In the past four years, the source of MDRO samples was the respiratory tract, followed by skin secretion and urine. In the past four years, the consumption of hand washing fluid was 4.90, 7.64, 10.86, 11.43 ml / bed day, and the consumption of quick-drying hand disinfectant was 1.77, respectively. Consumption of hand sanitizer, quick-drying hand disinfectant and toilet paper was negatively correlated with the incidence of MDRO nosocomial infection (correlation coefficients r were - 0.971, - 0.953, - 0.969, P were 0.05). Conclusion: The consumption of MDRO from 2013 to 2016 was negatively correlated with the incidence of MDRO nosocomial infection. The incidence and detection rate of nosocomial infections are decreasing year by year, which may be related to a series of interventions including the implementation of disinfection and isolation measures, strict hand hygiene of medical staff, and the increasing consumption of hand sanitizer, quick-drying hand disinfectant and hand wiping paper. Targeted prevention and control.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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