2014年贵州省苗族侗族自治州医院感染横断面调查

目的了解贵州省苗族侗族自治州医院医院感染现状，为医院感染防控措施的制定提供依据。方法按照全国医院感染监测网的统一部署，采用横断面调查方法，调查贵州省苗族侗族自治州26所医院医院感染现患率、抗菌药物使用情况及细菌培养送检率。结果共调查3所三级医院、23所二级医院7 799例住院患者，发生医院感染198例、205例次，医院感染现患率为2.54%，例次现患率为2.65%。综合重症监护病房（ICU）医院感染现患率最高，为29.63%；医院感染部位以下呼吸道为主（占44.44%）；医院感染病原体以革兰阴性（G-）菌为主，主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌等。抗菌药物使用率为45.66%，二级医院抗菌药物使用率为53.65%，高于三级医院的31.14%（χ2=148.53，P<0.001）。治疗用药占74.02%，预防用药占19.77%，预防+治疗用药占6.21%；抗菌药物单一用药比率占81.02%，二联占17.21%，三联及以上占1.77%；治疗用药及治疗+预防用药患者细菌培养送检率为29.37%。结论该地区医院感染现患率低于全国平均水平，抗菌药物使用率低于国家标准，应加强医院感染重点科室、重点部位的管理，合理使用抗菌药物，尤其是二级医院。

Cross sectional survey on healthcare associated infection in Miao and Dong Autonomous Prefecture of Guizhou Province in 2014

ObjectiveTo investigate the current situation of healthcare associated infection(HAI) in hospitals of Miao and Dong Autonomous Prefecture of Guizhou Province, and provide basis for formulating prevention and control measures of HAI.MethodsAccording to the unified plan of the National HAI Surveillance Network, 26 hospitals in Miao and Dong Autonomous Prefecture of Guizhou Province were performed cross sectional survey on HAI prevalence rate, antimicrobial use, and specimen bacterial culture rate.ResultsA total of 3 tertiary and 23 secondary hospitals were investigated, 7 799 inpatients were included, the prevalence rate of HAI was 2.54%(n=198), and case prevalence rate was 2.65% (n=205). HAI mainly distributed in intensive care unit (29.63%); the main infection site was lower respiratory tract (44.44%); HAI mainly caused by gram negative bacteria, the major pathogens were Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The usage rate of antimicrobial agents was 45.66%, secondary hospitals was higher than tertiary hospitals (53.65% vs 31.14%,χ2=148.53，P<0.001）.74.02% of antimicrobial agents were for therapeutic purpose, 19.77% for prophylaxis, and 6.21% for both prophylactic and therapeutic application; 81.02% of patients received one agent, 17.21% received two, and 1.77% received three and more agents; among patients who received antimicrobials for therapeutic as well as for both therapeutic and prophylactic purpose, only 29.37% were sent specimens for pathogenic detection.ConclusionThe prevalence rate in this region is lower than national average level, antimicrobial usage rate is lower than national standard, management of key departments and key sites should be strengthened, antimicrobial agents, especially used in secondary hospitals should be used rationally.