某綜合醫(yī)院多重耐藥菌感染狀況與變化趨勢(shì)
發(fā)布時(shí)間：2018-08-31 12:36
【摘要】：目的:通過對(duì)多重耐藥菌(MDRO)感染病例的監(jiān)測(cè),及時(shí)發(fā)現(xiàn)MDRO感染和定植患者,分析MDRO感染現(xiàn)狀和變化趨勢(shì),探討其可能的原因,從而確定MDRO防控的重點(diǎn)人群,以便更好地控制MDRO的產(chǎn)生和傳播。方法:自2013年至2016年,由院感專職人員和實(shí)驗(yàn)室工作人員每日通過醫(yī)院實(shí)驗(yàn)室信息系統(tǒng)(LIS)發(fā)現(xiàn)住院患者中檢出的MDRO菌株,剔除同一患者的重復(fù)標(biāo)本。監(jiān)測(cè)的MDRO有:多重耐藥/泛耐藥的鮑曼氏不動(dòng)菌(MDR/PDR-AB)、甲氧西林耐藥的金黃色葡萄球菌(MRSA)、多重耐藥/泛耐藥的銅綠假單胞菌(MDR/PDR-PA)、萬古霉素耐藥的腸球菌(VRE)、碳青霉烯類耐藥的腸桿菌科細(xì)菌(CRE)。2013年,發(fā)現(xiàn)住院患者中檢出MDRO菌株后,醫(yī)院感染科工作人員僅使用電話作為唯一方式告知患者所在病房對(duì)相應(yīng)的患者采取消毒和隔離措施,并且對(duì)病例進(jìn)行監(jiān)測(cè),也就是使用統(tǒng)一設(shè)計(jì)的調(diào)查表對(duì)患者進(jìn)行逐一記錄和追蹤,臨床病房自行完成相關(guān)的消毒隔離。2014年、2015年、2016年除了監(jiān)測(cè)MDRO病例外,還對(duì)此加以干預(yù)措施,主要包括消毒隔離的落實(shí)、手衛(wèi)生執(zhí)行情況的落實(shí)、加大MDRO知識(shí)的培訓(xùn)力度、加強(qiáng)重點(diǎn)環(huán)節(jié)管理、合理使用抗菌藥物,并逐年進(jìn)行“計(jì)劃Plan-執(zhí)行Do-檢查Check-糾正Action”(PDCA)質(zhì)量持續(xù)改進(jìn)措施。采取描述性流行病學(xué)研究方法,對(duì)2013年、2014年、2015年、2016年四年的MDRO感染狀況和變化趨勢(shì)進(jìn)行分析。結(jié)果:1.2013年至2016年共監(jiān)測(cè)MDRO醫(yī)院感染例數(shù)546例,四年總的MDRO醫(yī)院感染例次日發(fā)病率為0.24‰,2013年至2016年依次為0.32‰、0.24‰、0.21‰、0.18‰,逐年下降,差異有統(tǒng)計(jì)學(xué)意義(2趨勢(shì)c=25.829,P0.001)。四年共監(jiān)測(cè)MDRO例數(shù)1273例,四年MDRO檢出率為4.30%,2013年至2016年依次為4.84%、4.21%、4.12%、3.99%,逐年下降,差異有統(tǒng)計(jì)學(xué)意義(2趨勢(shì)c=6.554,P0.05)。四年中MRSA、MDR/PDR-PA的檢出率逐年下降(2趨勢(shì)c=51.719、21.154,P均0.001),CRE的檢出率逐年升高(2趨勢(shì)c=59.346,P0.001),差異均有統(tǒng)計(jì)學(xué)意義。VRE和MDR/PDR-AB的檢出率的差異無統(tǒng)計(jì)學(xué)意義(c2分別1.768、1.842,P均0.05)。2.2013至2016四年中的重癥監(jiān)護(hù)室(ICU)、干部科、燒傷科的MDRO醫(yī)院感染例次日發(fā)病率逐年下降,差異具有統(tǒng)計(jì)學(xué)的意義(2趨勢(shì)c分別為27.270、9.503、10.338,P均0.01)。神經(jīng)外科、移植科、耳鼻喉科、骨科、血液科、腎內(nèi)科、胸外科、其他科室的MDRO醫(yī)院感染例次日發(fā)病率的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。四年中MDRO例數(shù)和醫(yī)院感染例數(shù)分布最多的科室為ICU,其次為移植科、神經(jīng)外科等。移植科、神經(jīng)外科的MDRO醫(yī)院感染例數(shù)占檢出例數(shù)的比例較高,婦產(chǎn)科、感染科、呼吸科、中西醫(yī)結(jié)合科的比例較低。3.不同季度MDRO醫(yī)院感染例次日發(fā)病率和檢出率不同,第一季度最高,分別為0.36‰和4.46%,第四季度最低,分別為0.19‰和3.44%,差異均有統(tǒng)計(jì)學(xué)意義(c2=38.945、12.442,P均0.01)。第一季度MDRO醫(yī)院感染例數(shù)占檢出例數(shù)的比例最高,第四季度最低。4.四年中MDRO病例和醫(yī)院感染病例的病原體構(gòu)成主要以MDR/PDR-AB(35.27%和40.84%)和MRSA(40.14%和28.57%)為主。MSRA、MDR/PDR-PA例數(shù)和醫(yī)院感染例數(shù)及構(gòu)成比有所降低,CRE例數(shù)和醫(yī)院感染例數(shù)及構(gòu)成比有所升高。CRE醫(yī)院感染病例占MDRO檢出病例的比例最高,為69.23%,MRSA最低,為30.53%。5.MDRO醫(yī)院感染系統(tǒng)主要為呼吸系統(tǒng)(71.25%),其次為消化系統(tǒng)(12.45%)、血液系統(tǒng)、泌尿系統(tǒng)等。MRSA的主要感染部位是呼吸系統(tǒng)、皮膚和軟組織等;MDR/PDR-AB、MDR/PDR-PA、CRE的主要感染部位是呼吸系統(tǒng)、消化系統(tǒng)等;VRE的主要感染部位是消化系統(tǒng)、泌尿系統(tǒng)等。四年中,住院患者M(jìn)DRO標(biāo)本來源最多的為呼吸道,其次為皮膚分泌物、尿液等。6.四年中,洗手液消耗量分別為4.90、7.64、10.86、11.43ml/床日數(shù),速干手消毒劑消耗量分別為1.77、3.97、7.39、9.41ml/床日數(shù),擦手紙消耗量分別為2.36、5.42、9.31、10.54抽/床日數(shù),消耗量均逐年升高。洗手液、速干手消毒劑、擦手紙的消耗量與MDRO醫(yī)院感染例次日發(fā)病率呈負(fù)相關(guān)(相關(guān)系數(shù)r分別為-0.971、-0.953、-0.969,P均0.05)。結(jié)論:2013年至2016年MDRO醫(yī)院感染例次日發(fā)病率和檢出率逐年下降,可能與采取的包括落實(shí)消毒隔離措施、嚴(yán)格醫(yī)務(wù)人員手衛(wèi)生等一系列干預(yù)措施以及洗手液、速干手消毒劑和擦手紙消耗量逐年升高有關(guān)。應(yīng)進(jìn)一步對(duì)于高發(fā)科室、高發(fā)時(shí)間、重點(diǎn)人群、不同MDRO進(jìn)行有針對(duì)性的防控。
[Abstract]:OBJECTIVE: To detect MDRO infection and colonization in time by monitoring the cases of MDRO infection, analyze the current status and trend of MDRO infection, and explore the possible causes, so as to identify the key population for MDRO prevention and control, so as to better control the production and spread of MDRO. METHODS: From 2013 to 2016, full-time staff and practitioners from hospital infection were selected. Laboratory staff found MDO strains in hospitalized patients daily through the Hospital Laboratory Information System (LIS) and removed duplicate samples from the same patient. The MDO monitored included multidrug/pan-drug resistant Acinetobacter baumannii (MDR/PDR-AB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug/pan-resistant Pseudomonas aeruginosa. MDR / PDR - PA, Vancomycin - resistant Enterococcus (VRE), Carbapenem - resistant Enterobacteriaceae (CRE). In 2013, after the detection of MDRO strains in hospitalized patients, hospital infection staff only used the telephone as the only way to inform the patient's ward to take disinfection and isolation measures against the corresponding patients, and to improve the case In addition to monitoring MDRO cases in 2014, 2015 and 2016, interventions were also taken, including implementation of disinfection and isolation, implementation of hand hygiene, and training of MDRO knowledge. Strengthen the management of key links, rationalize the use of antibiotics, and carry out the "Plan-Do-Check-Correct Action" (PDCA) quality continuous improvement measures year by year. Adopt descriptive epidemiological methods to analyze the MDRO infection status and change trend in 2013, 2014, 2015 and 2016. In 2016, 546 cases of MDRO nosocomial infection were monitored. The incidence of MDRO nosocomial infection in four years was 0.24, 0.24, 0.21, 0.18, decreasing year by year from 2013 to 2016. The difference was statistically significant (2 trends C = 25.829, P 0.001). In four years, 1273 cases of MDRO were monitored. The detection rate of MDRO in four years was 4.30%, from 2013 to 2016. The detection rates of MRSA, MDR/PDR-PA decreased year by year (2 trends C = 6.554, P 0.05). The detection rates of CRE increased year by year (2 trends C = 51.719, 21.154, P 0.001). There was no significant difference between the detection rates of VRE and MDR/PDR-AB. The incidence of nosocomial infection of MDRO in ICU, Cadre and Burn Departments declined year by year from 2013 to 2014. The difference was statistically significant (2 trends C were 27.270, 9.503, 10.338, P were 0.01). Neurosurgery, transplantation, otorhinolaryngology, orthopedics, hematology, renal diseases There was no significant difference in the incidence of MDRO nosocomial infections in the following day among the departments of transplantation, thoracic surgery and other departments (P 0.05). The ICU was the most common one in the four years, followed by transplantation and neurosurgery. The incidence and detection rate of MDRO nosocomial infection in the first quarter were 0.36 and 4.46%, respectively. The lowest in the fourth quarter was 0.19 and 3.44%, respectively. The difference was statistically significant (c2 = 38.945, 12.442, P 0.01). The number of MDRO nosocomial infection cases in the first quarter accounted for the detection rate. The proportion of MDRO cases and nosocomial infections was the highest, and the lowest in the fourth quarter.4.In the four years, the main pathogens were MDR/PDR-AB (35.27% and 40.84%) and MRSA (40.14% and 28.57%). The infection cases accounted for the highest proportion of MDRO cases, 69.23%, MRSA lowest, 30.53%. 5. MDRO nosocomial infection system was mainly respiratory system (71.25%), followed by digestive system (12.45%), blood system, urinary system, etc. MRSA main infection sites were respiratory system, skin and soft tissue; MDR / PDR - AB, MDR / PDR - PA, CRE main infection sites. The major infection sites of VRE were the digestive system and urinary system. In the past four years, the source of MDRO samples was the respiratory tract, followed by skin secretion and urine. In the past four years, the consumption of hand washing fluid was 4.90, 7.64, 10.86, 11.43 ml / bed day, and the consumption of quick-drying hand disinfectant was 1.77, respectively. Consumption of hand sanitizer, quick-drying hand disinfectant and toilet paper was negatively correlated with the incidence of MDRO nosocomial infection (correlation coefficients r were - 0.971, - 0.953, - 0.969, P were 0.05). Conclusion: The consumption of MDRO from 2013 to 2016 was negatively correlated with the incidence of MDRO nosocomial infection. The incidence and detection rate of nosocomial infections are decreasing year by year, which may be related to a series of interventions including the implementation of disinfection and isolation measures, strict hand hygiene of medical staff, and the increasing consumption of hand sanitizer, quick-drying hand disinfectant and hand wiping paper. Targeted prevention and control.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R446.5
本文編號(hào)：2215006
[Abstract]:OBJECTIVE: To detect MDRO infection and colonization in time by monitoring the cases of MDRO infection, analyze the current status and trend of MDRO infection, and explore the possible causes, so as to identify the key population for MDRO prevention and control, so as to better control the production and spread of MDRO. METHODS: From 2013 to 2016, full-time staff and practitioners from hospital infection were selected. Laboratory staff found MDO strains in hospitalized patients daily through the Hospital Laboratory Information System (LIS) and removed duplicate samples from the same patient. The MDO monitored included multidrug/pan-drug resistant Acinetobacter baumannii (MDR/PDR-AB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug/pan-resistant Pseudomonas aeruginosa. MDR / PDR - PA, Vancomycin - resistant Enterococcus (VRE), Carbapenem - resistant Enterobacteriaceae (CRE). In 2013, after the detection of MDRO strains in hospitalized patients, hospital infection staff only used the telephone as the only way to inform the patient's ward to take disinfection and isolation measures against the corresponding patients, and to improve the case In addition to monitoring MDRO cases in 2014, 2015 and 2016, interventions were also taken, including implementation of disinfection and isolation, implementation of hand hygiene, and training of MDRO knowledge. Strengthen the management of key links, rationalize the use of antibiotics, and carry out the "Plan-Do-Check-Correct Action" (PDCA) quality continuous improvement measures year by year. Adopt descriptive epidemiological methods to analyze the MDRO infection status and change trend in 2013, 2014, 2015 and 2016. In 2016, 546 cases of MDRO nosocomial infection were monitored. The incidence of MDRO nosocomial infection in four years was 0.24, 0.24, 0.21, 0.18, decreasing year by year from 2013 to 2016. The difference was statistically significant (2 trends C = 25.829, P 0.001). In four years, 1273 cases of MDRO were monitored. The detection rate of MDRO in four years was 4.30%, from 2013 to 2016. The detection rates of MRSA, MDR/PDR-PA decreased year by year (2 trends C = 6.554, P 0.05). The detection rates of CRE increased year by year (2 trends C = 51.719, 21.154, P 0.001). There was no significant difference between the detection rates of VRE and MDR/PDR-AB. The incidence of nosocomial infection of MDRO in ICU, Cadre and Burn Departments declined year by year from 2013 to 2014. The difference was statistically significant (2 trends C were 27.270, 9.503, 10.338, P were 0.01). Neurosurgery, transplantation, otorhinolaryngology, orthopedics, hematology, renal diseases There was no significant difference in the incidence of MDRO nosocomial infections in the following day among the departments of transplantation, thoracic surgery and other departments (P 0.05). The ICU was the most common one in the four years, followed by transplantation and neurosurgery. The incidence and detection rate of MDRO nosocomial infection in the first quarter were 0.36 and 4.46%, respectively. The lowest in the fourth quarter was 0.19 and 3.44%, respectively. The difference was statistically significant (c2 = 38.945, 12.442, P 0.01). The number of MDRO nosocomial infection cases in the first quarter accounted for the detection rate. The proportion of MDRO cases and nosocomial infections was the highest, and the lowest in the fourth quarter.4.In the four years, the main pathogens were MDR/PDR-AB (35.27% and 40.84%) and MRSA (40.14% and 28.57%). The infection cases accounted for the highest proportion of MDRO cases, 69.23%, MRSA lowest, 30.53%. 5. MDRO nosocomial infection system was mainly respiratory system (71.25%), followed by digestive system (12.45%), blood system, urinary system, etc. MRSA main infection sites were respiratory system, skin and soft tissue; MDR / PDR - AB, MDR / PDR - PA, CRE main infection sites. The major infection sites of VRE were the digestive system and urinary system. In the past four years, the source of MDRO samples was the respiratory tract, followed by skin secretion and urine. In the past four years, the consumption of hand washing fluid was 4.90, 7.64, 10.86, 11.43 ml / bed day, and the consumption of quick-drying hand disinfectant was 1.77, respectively. Consumption of hand sanitizer, quick-drying hand disinfectant and toilet paper was negatively correlated with the incidence of MDRO nosocomial infection (correlation coefficients r were - 0.971, - 0.953, - 0.969, P were 0.05). Conclusion: The consumption of MDRO from 2013 to 2016 was negatively correlated with the incidence of MDRO nosocomial infection. The incidence and detection rate of nosocomial infections are decreasing year by year, which may be related to a series of interventions including the implementation of disinfection and isolation measures, strict hand hygiene of medical staff, and the increasing consumption of hand sanitizer, quick-drying hand disinfectant and hand wiping paper. Targeted prevention and control.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R446.5
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