2016年全国医院感染监测网手术后下呼吸道感染现患率调查

目的了解手术后下呼吸道感染发生科室、病原菌分布及其耐药情况，为制定其防治措施提供依据。方法对2016年3月15日-12月31日期间上报至全国医院感染监测网医院感染横断面调查资料中手术后下呼吸道感染监测数据进行汇总分析。结果1 588所医院共调查住院患者1 057 361例，发现下呼吸道医院感染12 827例次，其中手术后下呼吸道感染2 275例次，占下呼吸道医院感染的17.74%。手术后下呼吸道感染大多分布在外科，达1 700例次（占74.73%），其次为综合重症监护病房（372例次，占16.35%）；外科系统中以神经外科患者现患率最高（2.34%），其次为胸外科（1.71%）。共分离出病原体1 163株，革兰阴性菌占83.66%；居前5位的病原体依次为铜绿假单胞菌（20.29%）、肺炎克雷伯菌（19.69%）、鲍曼不动杆菌（19.69%）、大肠埃希菌（6.53%）和金黄色葡萄球菌（5.85%）。耐甲氧西林金黄色葡萄球菌（MRSA）、耐亚胺培南/美罗培南大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的检出率手术后下呼吸道感染分别为64.15%、8.00%、14.19%、29.14%、62.58%，非手术后下呼吸道感染分别为76.03%、8.85%、15.51%、39.67%、70.13%；铜绿假单胞菌对亚胺培南/美罗培南、鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率，手术后下呼吸道感染低于非手术后下呼吸道感染（后者为47.17% VS 63.68%），差异均有统计学意义（均P<0.05）。结论手术后下呼吸道感染以神经外科现患率最高，感染病原菌以革兰阴性菌占绝对优势，且耐药严重，但部分菌株的耐药情况较非手术后下呼吸道感染稍轻。

Prevalence rates of postoperative lower respiratory tract infection of National Healthcare associated Surveillance Network in 2016

ObjectiveTo understand department distribution, pathogens, and antimicrobial resistance of postoperative lower respiratory tract infection(LRTI), provide evidence for formulating prevention and treatment measures. MethodsFrom March 15, 2016 to December 31, 2016, monitored data of LRTI in the cross sectional survey of National Healthcare associated Infection Surveillance Network(NHAISN) were collected and analyzed. ResultsA total of 1 057 361 hospitalized patients in 1 588 hospitals were surveyed, 12 827 cases of LRTI occurred, 2 275 of which were postoperative LRTI, accounting for 17.74% of LRTI. Most LRTI occurred in patients in surgery departments (n=1 700 cases, 74.73%), followed by general intensive care unit (n=372 cases, 16.35%); among departments of surgery, prevalence rate of LRTI was highest in patients in department of neurosurgery (2.34%), followed by department of thoracic surgery (1.71%). A total of 1 163 strains of pathogens were isolated, gram negative bacteria accounted for 83.66%; the top 5 pathogens were Pseudomonas aeruginosa (20.29%), Klebsiella pneumoniae (19.69%), Acinetobacter baumannii (19.69%), Escherichia coli (6.53%), and Staphylococcus aureus (5.85%). Among pathogens causing postoperative LRTI, isolation rates of methicillin resistant Staphylococcus aureus, imipenem/meropenem resistant Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were 64.15%, 8.00%, 14.19%, 29.14%, and 62.58% respectively, isolation rate in non operative LRTI infection were 76.03%, 8.85%, 15.51%, 39.67%, and 70.13% respectively; resistance rate of Pseudomonas aeruginosa to imipenem/meropenem and Acinetobacter baumannii to cefoperazone/sulbactam were both higher in postoperative LRTI than in non postoperative LRTI(the latter were 47.17% vs 63.68%), difference were both significant(both P<0.05). ConclusionIncidence of postoperative LRTI is highest in department of neurosurgery, gram negative bacteria are the predominant pathogens, resistance of pathogens is serious, but antimicrobial resistance in partial strains are lower than non postoperative LRTI.