本文關(guān)鍵詞： 醫(yī)院內(nèi)感染 ICU 多重耐藥菌 病原菌　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1了解滄州市人民醫(yī)院重癥醫(yī)學(xué)科(Intansive Care Uint,ICU)醫(yī)院內(nèi)感染患病率和感染部位分布情況;2了解我院ICU醫(yī)院內(nèi)感染的病原學(xué)現(xiàn)狀、病原學(xué)的流行病學(xué)特征及其耐藥性;3探討醫(yī)院內(nèi)感染與侵入性操作的關(guān)系;4探討一系列感染防控措施對重癥醫(yī)學(xué)科(ICU)醫(yī)院內(nèi)感染及多重耐藥菌耐藥情況的影響,為預(yù)防控制ICU院內(nèi)感染提供依據(jù)。方法:1對ICU 2013年1月至2014年12月1269例住院患者進(jìn)行回顧性調(diào)查,根據(jù)調(diào)查內(nèi)容設(shè)計登記表;2采用前瞻性方法從2014年1月開始,實(shí)行ICU醫(yī)院感染管理目標(biāo)監(jiān)測,建立ICU醫(yī)院內(nèi)感染病例日志;3查閱ICU院感管理檔案,根據(jù)上報院感科的《院內(nèi)感染登記表》的相關(guān)數(shù)據(jù)和病歷資料,整理2013年1月至2014年12月ICU 170例發(fā)生醫(yī)院內(nèi)感染患者的臨床資料,包括一般資料及感染日期、侵入性操作、感染部位、病原學(xué)及其耐藥性。4用Excel軟件建立數(shù)據(jù)庫,統(tǒng)計分析采用SPSS17.0軟件。計數(shù)資料用率或構(gòu)成比描述,計數(shù)資料的比較采用卡方(χ2)檢驗(yàn)。以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1 2013年-2014年ICU發(fā)生醫(yī)院內(nèi)感染患者170例,感染例次254例次,醫(yī)院感染率13.40%,醫(yī)院感染例次率20.02%。2常見感染部位依次為下呼吸道(53.94%)、泌尿系(23.63%)、血液(15.35%)、腹腔(2.36%)、胸腔(2.36%)、手術(shù)切口(1.18%)。3呼吸機(jī)相關(guān)性肺炎、尿管相關(guān)泌尿系感染、導(dǎo)管相關(guān)血流感染與“三管”侵襲性操作有直接關(guān)系(P0.05)。4 2013-2014年醫(yī)院內(nèi)感染患者共分離出419株菌株,主要來源于痰培養(yǎng)248株,占59.19%;其次為尿培養(yǎng)68株,占16.22%;血培養(yǎng)46株,占10.98%;導(dǎo)管培養(yǎng)39株,占9.31%;胸水、腹水、手術(shù)切口等其他共18株,占4.30%。其中革蘭陰性菌267株,占63.72%;革蘭陽性菌110株,占26.25%;真菌42株,占10.03%。院內(nèi)感染病原菌總體排名前五位分別為鮑曼不動桿菌15.75%(66/419),銅綠假單胞菌14.08%(59/419),大腸埃希菌11.93%(50/419),金黃色葡萄球菌8.83%(37/419),肺炎克雷伯菌8.35%(35/419)。2014年與2013年比較,多重耐藥菌中銅綠假單胞菌的耐藥菌分離率有所上升,其它分離率50%的幾種多重耐藥菌分離率都呈下降趨勢,具有統(tǒng)計學(xué)意義。多重耐藥菌對常用抗生素存在多重耐藥,革蘭陰性菌對頭孢吡肟耐藥率較前上升。結(jié)論:ICU醫(yī)院內(nèi)感染率較高,感染部位以下呼吸道為主,呼吸機(jī)使用天數(shù)、保留尿管天數(shù)、中心靜脈置管保留天數(shù)、抗生素應(yīng)用與多重耐藥菌感染存在密切關(guān)系。ICU醫(yī)院內(nèi)感染分離出病原菌以革蘭陰性桿菌為主,且多為多重耐藥菌,分離出的院內(nèi)感染多重耐藥菌對常用抗生素的耐藥情況不同,耐藥率有明顯變化。2014年與2013年相比較,加強(qiáng)院內(nèi)感染防控措施,院內(nèi)感染發(fā)病率無明顯改善,考慮分析與多重因素有關(guān),包括病情危重程度,平均住院日等有關(guān)。
[Abstract]:Objective to investigate the prevalence and distribution of nosocomial infection in the Department of intensive Medicine (ICU) of Cangzhou people's Hospital. (2) to understand the etiological status, epidemiologic characteristics and drug resistance of ICU nosocomial infection in our hospital. 3To explore the relationship between nosocomial infection and invasive operation; 4 to explore the effect of a series of infection prevention and control measures on nosocomial infection and multidrug resistance of ICU. To provide the basis for preventing and controlling the nosocomial infection of ICU. Methods: a retrospective survey of 1269 inpatients with ICU from January 2013 to December 2014 was carried out. Design registration form according to the content of investigation; (2) from January 2014, ICU hospital infection management objective monitoring was carried out, and the ICU nosocomial infection case log was established. (3) to consult the hospital sense management files of ICU, according to the relevant data and medical records of the nosocomial infection registration form reported to the hospital feeling department. The clinical data of 170 ICU patients with nosocomial infection from January 2013 to December 2014 were collected, including general information, date of infection, invasive operation and site of infection. Excel software was used to establish the database of etiology and drug resistance. SPSS17.0 software was used for statistical analysis. The data consumption rate or composition ratio was described. The count data were compared by chi-square test (蠂 ~ 2) test. The difference was statistically significant with P0.05. Results from 2013 to 2014, 170 patients with ICU had nosocomial infection. 254 cases were infected, the nosocomial infection rate was 13.40%, the nosocomial infection rate was 20.02.2% and the common infection site was lower respiratory tract (53.94). The urinary system was 23.63m, the blood was 15.35m, the abdominal cavity was 2.36m, the thoracic cavity was 2.36cm, the operative incision was 1.180.3. ventilator-associated pneumonia. Urinary tract infection associated with catheterization. A total of 419 strains were isolated from patients with nosocomial infection in 2013-2014. There was a direct relationship between catheter-related blood flow infection and invasive operation of "three tubes". 248 strains of sputum were mainly derived from sputum culture, accounting for 59.19%. The next was urine culture 68 strains (16.22%); 46 strains (10.98%) were cultured in blood. 39 strains (9.31%) were cultured through catheter. There were 18 strains of hydrothorax, ascites, surgical incision and so on, accounting for 4.30.The gram-negative bacteria accounted for 267 strains (63.72%); There were 110 Gram-positive bacteria (26.25%); There were 42 strains of fungi, accounting for 10.03.The top five pathogens of nosocomial infection were Acinetobacter baumannii 15.7566 / 419 respectively. Pseudomonas aeruginosa 14.08 involved 59 / 419, Escherichia coli 11.93 / 419, Staphylococcus aureus 8.83 / 419). Klebsiella pneumoniae 8.35 / 4190.Compared with 2013, the isolation rate of Pseudomonas aeruginosa from multidrug resistant bacteria increased in 2014. The isolation rates of other multidrug resistant bacteria with 50% were decreased, and there was statistical significance. The multidrug resistant bacteria were multidrug resistant to common antibiotics. Conclusion the nosocomial infection rate of Gram-negative bacteria to cefepime is higher than that of the former. Conclusion the infection rate in the hospital is higher. The respiratory tract below the infection site is the main infection site, the days of ventilator use, and the days of retention of urinary catheter. There was a close relationship between antibiotic use and multidrug resistant bacteria infection. Gram-negative bacilli were the main pathogens in ICU hospital infection, and most of them were multidrug resistant bacteria. The drug resistance of multidrug resistant bacteria isolated from nosocomial infection to common antibiotics was different, and the drug resistance rate was obviously changed. In 2014, compared with 2013, the measures of prevention and control of nosocomial infection were strengthened. The incidence of nosocomial infection was not significantly improved. The analysis was related to multiple factors, including the severity of the disease and the average length of stay.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄒英,冷泰俊,徐永濤,徐順軍;1022株細(xì)菌培養(yǎng)結(jié)果與藥敏的分析[J];第三軍醫(yī)大學(xué)學(xué)報;2001年07期

2 封永順;張琦;;重癥醫(yī)學(xué)科醫(yī)院感染及病原菌分布觀察[J];吉林醫(yī)學(xué);2013年12期

3 張輝;張小江;徐英春;胡志東;李金;孫自鏞;簡翠;汪復(fù);朱德妹;卓超;蘇丹虹;褚云卓;俞云松;林潔;徐元宏;沈繼錄;倪語星;孫景勇;張朝霞;季萍;魏蓮花;吳玲;王傳清;薛建昌;張泓;李萬華;胡云建;艾效曼;單斌;杜艷;;2012年中國CHINET不動桿菌屬細(xì)菌耐藥性監(jiān)測[J];中國感染與化療雜志;2014年05期

4 陳綺虹,張惠玲;留置硅膠尿管與乳膠尿管患者舒適度比較[J];實(shí)用醫(yī)學(xué)雜志;2005年18期

5 戢運(yùn)超;;2568株革蘭陰性桿菌的感染情況及耐藥性分析[J];現(xiàn)代醫(yī)學(xué);2014年03期

6 張小江,王輝,徐英春,謝秀麗,陳民鈞;重癥監(jiān)護(hù)病房最常見革蘭陰性桿菌的耐藥變遷[J];中華醫(yī)院感染學(xué)雜志;2004年10期

7 楊大國,馬漢武,肖偉,蘇健,胡瑛,鐘旬華;深圳市醫(yī)院感染現(xiàn)患率調(diào)查與分析[J];中華醫(yī)院感染學(xué)雜志;2004年11期

8 黃峰;付林;袁光雄;;重癥醫(yī)學(xué)科室病房院內(nèi)感染病原學(xué)分析及預(yù)防[J];醫(yī)學(xué)理論與實(shí)踐;2013年08期

9 陳鵑;;深靜脈置管不同部位細(xì)菌污染與導(dǎo)管相關(guān)感染的分析[J];中華醫(yī)院感染學(xué)雜志;2013年13期

10 胡生梅;史莉;;286株鮑曼不動桿菌臨床分布及耐藥性分析[J];襄陽職業(yè)技術(shù)學(xué)院學(xué)報;2014年02期

，

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