青海省某三甲医院2010-2017年医院感染现患率调查

目的 了解青海省某院2010-2017年医院感染现患情况及变化趋势。方法 采用病历调查与床旁调查相结合的方法，对2010-2017年各年份该院某日的所有住院患者医院感染情况、抗菌药物使用情况、医院感染病原体及治疗性使用抗菌药物细菌培养送检情况进行调查。结果 8次横断面调查共调查住院患者12 446例，发生医院感染488例，555例次。医院感染现患率为3.92%，例次现患率为4.46%。各年份医院感染现患率为2.93%~5.70%。医院感染现患率最高的科室为综合重症监护病房（ICU），为58.72%；医院感染部位主要为下呼吸道（279例次）。各年份抗菌药物使用率比较，差异有统计学意义（χ²=135.98，P<0.01），由2010年的55.56%下降至2017年的16.05%。抗菌药物使用以治疗用药为主（65.74%），治疗用药所占比率逐渐下降；以一联用药为主（91.52%），2011-2017年三联及以上用药比率均为0。各年份治疗性使用抗菌药物病原学送检率比较，差异有统计学意义（χ²=57.48，P<0.05）。共检出病原体203株，以革兰阴性（G^-）菌为主，占67.98%（138株），革兰阳性（G⁺）菌占25.62%（52株），其余为真菌及其他病原体。结论 该院医院感染现患率总体较平稳，抗菌药物使用及治疗性使用抗菌药物病原学送检逐步得到规范，需密切关注ICU、神经外科、血液科等科室的医院感染管理工作。

Prevalence rates of healthcare-associated infection in a tertiary first-class hospital in Qinghai Province from 2010 to 2017

Objective To understand the current situation and changing trend of healthcare-associated infection(HAI) in a hospital of Qinghai Province from 2010 to 2017. Methods Medical record review and bedside survey was adopted to investigate the occurrence of HAI, antimicrobial use, pathogens causing HAI, and bacterial culture(therapeutic antimicrobial use) of all inpatients in one day of each year from 2010 to 2017. Results A total of 12 446 inpatients were investigated in 8 cross-sectional surveys, 488 patients had 555 cases of HAI. HAI rate and HAI case rate were 3.92% and 4.46% respectively. Prevalence of HAI in each year were 2.93%-5.70%. The highest prevalence of HAI was found in ICU (58.72%), and the main site of HAI was lower respiratory tract (n=279). There was a significant difference in the usage rate of antimicrobial agents in each year (χ²=135.98,P<0.01), decreased from 55.56% in 2010 to 16.05% in 2017. The use of antimicrobial agents were mainly therapeutic (65.74%), proportion of therapeutic antimicrobial use gradually declined; 91.52% were antimicrobial monotherapy, proportion of combined use of at least three antimicrobial agents was 0 in 2011-2017. There was a significant difference in pathogenic detection of therapeutic antimicrobial use among each year (χ²=57.48,P<0.05). A total of 203 pathogens were isolated, the main pathogens were gram-negative bacteria (n=138, 67.98%) and gram-positive bacteria (n=52, 25.62%), followed by fungi and other pathogens. Conclusion The prevalence of HAI in this hospital is generally stable, antimicrobial use and pathogenic detection of therapeutic antimicrobial use are gradually standardized, close attention should be paid to the management of HAI in ICU, departments of neurosurgery and hematology.