某院2004-2006年住院患者医院感染调查

目的探讨某综合性医院的医院感染临床特点。方法采用前瞻性和回顾性调查相结合的方法，对该院2004-2006年住院患者的出院病历进行调查。结果共调查51021份病历，患者医院感染率为5．39％（2748例），其中重症监护室（ICU）38．33％，神经内科12．05％，神经外科13．29％，烧伤科9．57％。3225例次（6．32％）感染中，以呼吸道感染为主，其中下呼吸道感染987例（30．61％），上呼吸道感染719例（22．29％）；其次是泌尿道感染485例（15．04％）。共检出病原菌2129株，真菌构成比呈增高趋势（χ^2=16．84，P〈0．05）；革兰阴性菌检出3年差异无显著性（χ^2=4．83，P〉0．05），但铜绿假单胞菌所占构成比呈下降趋势（χ^2=26．28，P〈0．05）；革兰阳性菌的检出3年差异亦无显著性（χ^2=3．70，P〉0．05），但金黄色葡萄球菌所占构成比呈下降趋势（χ^2=6．63，P〈0．05）。结论医院感染真菌有上升趋势，应针对重点科室加强管理，尽量减少并规范指导侵袭性操作，临床医生应合理使用抗菌药物，以有效预防与控制医院感染。

Investigation on nosocomial infection in inpatients in a hospital between 2004 and 2006

Objective To evaluate the clinical characteristics of nosocomial infection（NI） in a general hospital. Methods Medical records of inpatients who were hospitalized in a hospital between 2004 and 2006 were surveyed with prospective and retrospective combination methods. Results A total of 51 021 medical records were surveyed, NI rate was 5. 39% （2 748 cases）, the NI rate in patients in ICU, internal neurology, neurosurgery and burn unit was 38.33%, 12. 05%, 13. 29% and 9. 57% respectively. Among 3 225 cases（6. 32%） infection, 987 cases （30. 61%）,719（22. 29%） and 485 cases （15. 04%） were lower respiratory tract infection, upper respiratory tract infection and urinary tract infection. A total of 2 129 pathogenic strains were detected, the constitute ratio of fungi had a tendency of rising （χ^2 = 16. 84, P〈0. 05） ;there was no obvious difference in the detection rate of gram-negative bacteria during three 3 years （χ^2 = 4. 83, P〉0. 05）, but the constitute ratio of Pseudomonas aeruginosa had a tendency of decreasing （χ^2 = 26. 28, P〈0. 05） ,there was also no significant difference in the detection rate of grampositive bacteria during three 3 years （χ^2 = 3. 70, P〉0. 05）, but the constitute ratio of Staphylococcus aereus had a tendency of decreasing （χ^2 = 6. 63, P〈0. 05）. Conclusion Nosocomial fungal infection had a rising tendency, the key departments should be given strengthened management, invasive operation should be reduced and standardized, clinicians should use antimicrobial agents rationally, so as to prevent and control nosocomial infection.