目的 了解综合重症监护病房（ICU）呼吸机相关性肺炎（VAP）感染率、危险因素、病原菌分布及其耐药情况，探讨有针对性的预防控制措施。 方法 2009年1月－12月综合ICU共收治患者447例，采用主动监测方法，由ICU医务人员和专职人员每日对综合ICU病房住院时间≥48 h且撤停机械通气后48 h内的患者进行VAP监测。 结果 447例患者中住院时间≥48 h的患者168例，96例患者使用呼吸机，使用呼吸机时间182 d，ICU住院总日数1 339 d，发生VAP 17例，呼吸机使用率13.59%，VAP感染率93.4例/1 000机械通气日，根据平均病情严重程度（ASIS法）调整后的VAP感染率为2.38%。呼吸机使用方式与VAP发生有关联。检出病原菌18株，全部为Gˉ杆菌，其中鲍曼不动杆菌4株，对包括硫霉素、氨曲南在内的多种抗菌药物耐药。 结论 综合ICU病房VAP感染率为2.38%，呼吸机使用不当是VAP的危险因素，VAP致病菌为Gˉ杆菌，其中鲍曼不动杆菌耐药率达100%，并呈多重耐药性；抗生素使用时间过长，预防性使用不当是致病菌产生多重耐药的重要原因。
ObjectiveTo learn the status quo and characteristics of multi-drug resistant organism (MDRO) infection in a comprehensive hospital of the first grade in Sichuan Province, analyze the effect of prevention and control intervention, in order to provide a scientific basis for clinical MDRO prevention and control. MethodsWe collected MDRO data from January to June 2014 and from January to June 2015 through multi-drug resistance reporting software, and analyzed and compared the infection of MDRO during those two time periods. Then, we evaluated the prevention and control effect of MDRO infection. ResultsThe number of inpatients from January to June 2014 was 24709, among which 813 were detected with MDRO infection. Of those infected patients, 196 had nosocomial infection of MDRO and the other 617 had community infection/colonization. The proportion of nosocomial MDRO infection was 24.10%. The MDRO nosocomial infection case rate was 0.79%. The proportion of community MDRO infection/colonization was 75.90%. The number of inpatients from January to June 2015 was 25329, and 739 of them were found with MDRO infection, of whom 132 had nosocomial infection and 607 community infection/colonization. The proportion of nosocomial MDRO infection was 17.86%. The MDRO nosocomial infection case rate was 0.52%. The proportion of community infection/colonization was 80.14%. Compared with the first half of 2014, the proportion of nosocomial MDRO infection was lower with a statistically significant difference (χ2=9.062, P<0.001), and MDRO nosocomial infection case rate was also significantly lowered (χ2=14.220, P<0.001). There were significant differences between the first half of 2015 and the same period of 2014 in hospital department distribution of MDRO infection, patient infection site distribution and pathogen detection. ConclusionThe nosocomial MDRO infection control situation of our hospital is improved after the comprehensive prevention and control interventions, and we should focus on the prevention and control of key departments, important infection sites and major resistant bacteria in the future MDRO hospital infection control work.
目的 对烧伤层流病房多重耐药菌感染的相关因素进行分析，通过护理干预来预防和减少烧伤病房多重耐药菌感染的发生。 方法 回顾性分析2011年1月－12月收治的629例烧伤患者，其中发生多重耐药菌感染74例，感染率为11.8%。 结果 感染部位：创面分泌物培养感染占70.2%，痰液标本培养感染占9.4%，血液标本培养感染占16.2%，其他占4.2%。感染病原菌：以金黄色葡萄球菌为主，占77.0%；鲍曼不动杆菌占4.2%，铜绿假单胞菌占10.8%，肺炎克雷伯菌占6.7%，真菌感染占1.3%。 结论 对发生医院内多重耐药菌感染的原因进行分析并及时采取相应的护理干预措施，及可行的医院感染管理控制措施，对烧伤患者预后有重要的意义，可有效降低院内感染率的发生。
Medical institutions of China still face two challenges in hospital infections currently: one challenge is from infection, including infectious diseases, multidrug-resistant bacteria healthcare-associated infection (HAI), and classic HAI; the another challenge comes from the management of HAI in medical institutions, such as lack of full-time staff and insufficient capacity, inadequate infection control organizations, insufficient awareness of infection control among medical staff, and unbalanced development. To cope with these severe challenges, we must do the following three aspects: establishing the discipline of HAI, and improving people’s infection control ability through human-orienting; improving the management organization and system of HAI; improving the awareness of infection control among all medical staff, carrying out scientific and orderly infection prevention and control work in accordance with the law, and adhering to evidence-based infection control.
Objective To investigate the antibiotic resistance distribution and profiles of multidrug resistant bacteria in respiratory intensive care unit ( RICU) , and to analyze the related risk factors for multidrug resistant bacterial infections. Methods Pathogens from79 patients in RICU from April 2008 to May 2009 were analyzed retrospectively. Meanwhile the risk factors were analyzed by multi-factor logistic analysis among three groups of patients with non-multidrug, multidrug and pandrug-resistant bacterialinfection. Results The top three in 129 isolated pathogenic bacteria were Pseudomonas aeruginosa ( 24. 0% ) , Staphylococcus aureus( 22. 5% ) , and Acinetobacter baumannii( 15. 5% ) . The top three in 76 isolated multidrug-resistant bacteria were Staphylococcus aureus ( 38. 9% ) , Pseudomonas aeruginosa ( 25. 0% ) , and Acinetobacter baumannii( 19. 4% ) . And the two main strains in 29 isolated pandrug-resistant bacteria were Pseudomonas aeruginosa ( 48. 3% ) and Acinetobacter baumannii ( 44. 8% ) . Multi-factor logistic analysis revealed that the frequency of admition to RICU, the use of carbapenem antibiotics, the time of mechanical ventilation, the time of urethral catheterization, and complicated diabetes mellitus were independent risk factors for multidrug-resistant bacterial infection( all P lt; 0. 05) . Conclusions There is a high frequency of multidrug-resistant bacterial infection in RICU. Frequency of admition in RICU, use of carbapenem antibiotics, time of mechanical ventilation, time of urethral catheterization, and complicated diabetes mellitus were closely related withmultidrug-resistant bacterial infection.
ObjectiveTo analyze the distribution and drug resistance of Enterobacteriaceae in West China Hospital of Sichuan University, to provide long-term monitoring data references for clinical practice.MethodsThe clinical information of non-repetitive Enterobacteriaceae isolates from 2006 to 2015 was collected and analyzed. All the isolates were identified by VITEK-2 Compact Automatic Microbial Identification Analyzer (Bio Merieux, France). The statistic informations were analyzed by WHONET 5.6 and iLabDataforMDR 1.03.ResultsA total of 38 487 strains of Enterobacteriaceae were isolated from 2006 to 2015, mainly including 14 862 stains of Escherichia (38.6%), 12 894 stains of Klebsiella (33.5%), 6 277 stains of Enterobacter (16.3%), 1 758 stains of Proteus (4.6%), 1 257 stains of Serratia (3.3%), 933 stains of Citrobacter (2.4%), and 506 stains of Morganella (1.3%). The top three sample types were sputum (46.9%), urine (18.7%), and secretions (11.5%). The drug resistance rate of Enterobacteriaceae showed a downward trend to most antibacterials. The average resistance rate of Enterobacteriaceae to ampicillin, ampicillin/sulbactam, and cefazolin was 85.3%, 52.6%, and 72.9%, respectively. The resistance rates to ceftriaxone, cefepime, gentamicin, and tobramycin were significantly reduced. The resistance rates to other antibiotics showed decreasing or slow increasing trends. The isolation rate of extended-spectrum β-lactamases (ESBL)-producing strains in Escherichia did not change, but the rate in Klebsiella decreased significantly. The isolation rate of multidrug-resistant organisms (MDRO) showed a slow decrease.ConclusionsThe overall antimicrobial resistance and the isolation rates of MDRO and ESBL-producing organisms showed a downward trend in investigating period. However, the carbapenem-resistant Enterobacteriaceae was rising continuously. Long-term monitoring of drug resistance is of notable value to antibiotic management policies.
Objective To investigate the risk factors of multidrug-resistant organism (MDRO) infection in patients with car accident injuries in intensive care unit (ICU), providing clinical guidance for reducing MDRO infection in car accident patients. Methods The clinical data of patients with car accident injuries in Sichuan Provincial People’s Hospital between January 1st 2019 and February 28th 2023 were collected, and the relevant data were analyzed retrospectively to explore the risk factors of MDRO infection. Results A total of 141 patients with car accident injuries were collected, of whom 30 had MDRO infection. The proportions of males (P=0.012), indwelling catheters (P=0.005), mechanical ventilation (P=0.001), length of hospital stay (P<0.001), and total treatment costs (P<0.001) in the infection group were higher than those in the non-infection group. Multiple logistic regression analysis showed that male [odds ratio (OR)=3.797, 95% confidence interval (CI) (1.174, 12.275), P=0.026], mechanical ventilation [OR=4.596, 95%CI (1.538, 13.734), P=0.006], and length of hospital stay≥20 d [OR=1.014, 95%CI (1.001, 1.028), P=0.037] were independent risk factors for MDRO infection in car accident patients. Conclusions Male, mechanical ventilation, and increased length of hospital stay are independent risk factors for MDRO infection in car accident patients. For such patients, the prevention and control measures of hospital infection should be strictly implemented to reduce the risk of infection.
目的 了解新生儿患者多重耐药菌社区感染的特点和定植情况，采取预防控制措施，防止在院内传播。 方法 对2011年9月－2012年8月所有新入院新生儿患者共801例进行耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）和产超广谱β内酰胺酶（ESBL）菌入院筛查，了解多重耐药菌社区感染的特点和定植情况。并将801例新生儿患者（观察组）医院感染发生率与2010年9月－2011年8月同期801 例新生儿患者（对照组）医院感染发生率进行比较。 结果 观察组发现MRSA和产ESBL菌共321例，检出率为40.1%。其中包括单纯MRSA 45例，占14.1%；产ESBL菌238例，占74.1%；MRSA+产ESBL菌38例，占11.8%。观察组医院感染发生率为2.0%，多重耐药菌医院感染构成比为12.5%；对照组医院感染发生率为5.1%，多重耐药菌医院感染构成比为53.6%；两组医院感染发生率和多重耐药菌医院感染构成比差异均有统计学意义（P＜0.01）。 结论 新生儿患者多重耐药菌定植情况严重，应引起高度重视，加强管理可防止在医院传播，减少医院感染发生。