医院感染有效监控与合理治疗的实践与认识

目的探讨医院感染监控与治疗.方法对1993～2003年传染病院肝脏疾病患者,医院感染状况进行回顾性分析.结果医院感染疾病,原发性细菌性腹膜炎居首,败血症其次,深部真菌感染发生率17%,肝衰竭患者中发生率占32%,病死率高达82.1%;真菌性肺炎感染率是真菌感染的51.2%,病死率占94.7%;医院感染优势病原菌,革兰阴性菌占60%～70%,大肠埃希菌居首占45.6%;真菌感染中白色念珠菌为主要菌占79%,曲霉菌占13.1%;产超广谱β-内酰胺酶(ESBLs)细菌、凝固酶阴性葡萄球菌占85%,肠球菌属占40%,大肠埃希菌和肺炎克雷伯菌分别为23.2%和23.8%.结论医院感染危及生命、病死率最高是真菌性肺炎和真菌性败血症;多种耐药细菌警示,产超广谱β-内酰胺酶(ESBLs)细菌增多,耐药菌与抗生素管理监控和合理治疗是关键.

Nosocomial Infection: A Clinical Investigation of Control and Treatment

OBJECTIVE To discuss the control and treatment of nosocomial infection. METHODS We analyzed all the serious hepatitis cirrhosis patients in 1993-2003 in infectious hospital. RESULTS Among nosocomial infection diseases, the first was peritonitis, the next was septicemia. Morbidity of systemic fungal infection was 17%> hepatic failure was 32% , and its mortality was 82. 1%. Among fungal infections, fungal pneumonitis was about 51. 2% , mortality was 94. 7%. Candida albicans infection among fungi was about 79% , aspergillosis was about 13. 1%. Among main becteria of nosocomial infection, the first was Escherichia coli 45. 6%. Extended-spectrum BBBBBBB-lactamases (ESBLs)-producing bacteria, and coagulase-negative staphylococci (CNS) were 85%, Enterococcus were 40% , Klebsiella pneumoniae and Escherichia coli were about 23. 8% and 23. 2%. CONCLUSIONS Fungal peritonitis and septicemia of nosocomial infection are with the high death rates due to multi-resistant bacilli, to which we must pay more attention. Due to increase in ESBLs it is important to manage the antibiotic use and the multi-resistant bacteria survey in order to proper use of antimicrobial agents.