湖北省25所医院ICU医院感染目标性监测结果分析

目的 了解湖北省医院重症监护病房（ICU）患者医院感染现状特点，为医院感染防控措施的制定提供依据。方法 采用前瞻性调查方法对湖北省25所医院ICU患者进行医院感染目标性监测，数据录入全国医院感染监测与数据直报系统，采用Excel 2010进行统计学分析。结果 共监测24 957例患者，医院感染发病率为3.71%，医院感染部位以下呼吸道为主，占73.41%。呼吸机相关肺炎（VAP）、血管导管相关血流感染（CRBSI）、导尿管相关尿路感染（CAUTI）发病率分别为11.36‰、1.23‰、1.29‰。926例感染患者共分离出950株病原菌，以革兰阴性菌为主（76.53%）。前5位病原菌依次为鲍曼不动杆菌(22.63%)、肺炎克雷伯菌（17.26%）、铜绿假单胞菌(11.79%)、金黄色葡萄球菌(8.95%)、大肠埃希菌（6.21%）。结论 侵入性操作是ICU患者医院感染的高风险因素，其中以VAP感染发病率最高。医院感染病原菌耐药情况较重，应持续监测并采取相应干预措施控制医院感染。

Analysis of targeted surveillance on nosocomial infection in intensive care units of 25 hospitals in Hubei province

Objective The aim of this study was to assess the current status of nosocomial infection(NI) in patients from intensive care unit(ICU) in Hubei province, in order to provide basis for the establishment for prevention and control measures of NI. Methods Targeted surveillance was performed on ICU patients from 25 hospitals in Hubei province using prospective investigative methods. The monitoring information was put into the nosocomial infection surveillance and data reporting system, and statistical analysis was performed using Excel 2010. Results A total of 24957 patients were recruited in 2016, and the incidence of NI was 3.71%. The lover respiratory tract was the main site of infection, accounting for 73.41%. The ventilator-associated pneumonia (VAP) infection rate, catheter related blood stream infection (CRBSI) rate and catheter-associated urinary tract infection(CAUTI) rate were 11.36‰, 1.23‰, and 1.29‰, respectively. 950 strains of pathogenic bacteria were isolated from 926 cases of nosocomial infection, most of which were gram-negative bacteria(75.63%). The top five isolated pathogens were Acinetobacter baumannii(22.63%), Klebsiella pneumonia(17.26%), Pseudomonas aeruginosa (11.79%), Staphylococcus aureus (8.95%) and Escherichia coli (6.21%). Conclusion Invasive procedures were a high-risk factor for NI of patients in ICU. The VAP infection rate was the highest in device-associated infection. The pathogens causing NI were often multidrug-resistant. Continuous monitoring should be carried out and corresponding intervening measures should be taken so as to control the occurrence of NI.