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你可能喜欢研究目的1)了解ICU病房医院感染的发病率和感染部位分布情况；2)了解ICU医院感染的病原菌的种类和分布情况；3)针对细菌药敏结果指导临床合理使用抗生素,同时提高治疗水平；4)分析疾病危险因素对医院感染的影响；5)为预防和控制医院感染和做好医务人员个人防护提供依据。研究对象和方法以2010年1月到12月该科室登记的全部出院患者作为研究对象,进行回顾性调查,通过查阅病历、医院感染登记本等,填写统一的调查表,调查其中的医院感染病例。调查内容包括性别、年龄、入院诊断以及疾病的预后；是否发生医院感染、医院感染的部位、时间及病原体种类和名称；病原菌送检标本名称及药敏实验结果；各种危险因素：如呼吸机使用情况、泌尿道插管和动静脉插管、是否行放化疗、免疫抑制剂和激素的使用情况以及抗菌药物使用情况等。将调查表资料统一进行EXCEL电子表格统计数据和汇总,采用SPSS 18.0软件系统对数据进行统计描述和分析。研究结果1)医院感染发病率2010年该科室出院患者病历486例,其中发生医院感染的共119例,感染发病率为24.56%；发生医院感染171例次,感染例次率为35.19%2)发生医院感染的性别构成在本次调查486例患者中,男性301例,发生医院感染的90例,感染率29.90%；女性184例,发生医院感染的29例,感染率15.76%。3)发生医院感染的年龄构成发生医院感染的患者年龄10-92岁(61.52±19.37)岁。4)与住院时间的关系发生医院感染时间最短的是住院第3天,最长的是住院第40天,平均7.97天。5)发生医院感染的患者预后发生医院感染的患者中,预后为死亡的37例,占31.36%；未愈的患者12例,占10.17%;好转患者65例,占55.08%；自动出院患者4例,占3.39%。6)感染部位分布最常见的为下呼吸道,占62.65%,其次为泌尿道,占15.66%,腹腔占6.02%。7)病原菌种类共分离病原菌223株,其中革兰氏阴性菌164株,占73.55%(鲍曼不动杆菌73株,占32.74%;铜绿假单胞菌37株,占16.59%；肺炎克雷伯菌16株,占7.17%)；革兰氏阳性菌27株,占12.12%(MRSA11株,占4.93%)；真菌32株,占14.36%(白色念珠菌14株,占6.28%；热带念珠菌10株,占4.48%。8)不同感染部位病原菌分布情况下呼吸道感染最常见病原菌为革兰氏阴性菌,占72.69%,革兰氏阳性菌占12.78%,真菌占14.54%。泌尿道感染最常见的病原菌为真菌,占84.21%。腹腔感染革兰氏阴性菌占62.50%,革兰氏阳性菌为37.50%。导管相关性感染以革兰氏阳性菌多见(55.56%)。9)病原菌耐药性鲍曼不动杆菌耐药率依次为头孢噻肟(100%)、亚胺培南(98.61%)、美罗培南(98.59%)、头孢吡肟(98.04%)、头孢他啶(97.06%)。铜绿假单胞菌耐药率依次为氧氟沙星(40.54%)、美罗培南(37.84%)、左氧氟沙星(33.33%)。10)医院感染相关危险因素分析采用单因素条件logistic回归分析方法对18个相关因素进行分析,结果显示,恶性肿瘤、昏迷、气管插管或切开、手术、手术切口类型、联合使用抗生素、动静脉插管、急症手术、导尿、放疗、化疗、激素、免疫抑制剂的应用、呼吸机等14个因素成为可能的危险因素。将单因素分析中的危险因素引入多因素条件logistic回归模型,发现气管插管或切开、手术、导尿、动静脉插管、联合使用抗生素这5个因素是ICU医院感染的主要危险因素。结论ICU医院感染发病率居高不下,因此,预防和控制医院感染仍然是医务人员面临的首要问题。目前,ICU医院感染的感染部位仍以呼吸道为主,应加强空气传播的防护,定时通风,减少疾病的空气传播。病原菌因感染部位不同而不同,菌种复杂,耐药菌株多,应有针对性的对ICU医院感染的具体环节予以控制。掌握病原菌变化规律,降低耐药菌的产生,提高治疗水平,从而提高整个预防和控制医院感染的水平。
OBJECTIVE1) to evaluate the incidence and the distribution of nosocomial infection in the intensive unit at our hospital.2)to evaluate the distribution of pathogens of nosocomial infection in ICU.3)According to the bacteria antimicrobial susceptibility test results, to rationally use antibiotics in ICU,and to improve treatment level of infection.4)To analyze the risk factors for nosocomial infection.5)To provide evidence for the prevention and management of nosocomial infection and individual protection of staff in ICU.SUBJECT and METHODThe 486 medical record out ICU patients were retrospectively analyzed during January～December 2010, by referring to medical record and nosocomial infection register to investigate the prevalence of nosocomial infection.The investigated content mainly include gender,age,primary diagnoses and the prognlocation of infection,date of infection,pathogenic bacterium
risk factors,such as mechanical ventilation,arteriovenous catheter and urinary catheter, radiochemotherapy, the use of immunosuppressive agents and steroid hormone drugs,and information of using antibiotics.RESULT1) The nosocomial infection rates:Among the 486 ICU patients,119 people got the nosocomial infection(25.64%),with 171 infection cases in total(35.19%).2) Sex distribution:90 people got infection among the 301 male patients(29.90%); 29 people got infection among the 184 female patients. 3) Age distribution:The ages of the infectors were between 10 to 92 (61.52±19.37).4) The relationship between nosocomial infection and hospitalization time:The hospitalization time of the infectors were between 3 days to 40days, with an average of 7.97 days.5) The prognosis:Among the infectors,37 died(31.36%),12 were not improved(10.17%),65 were improved(55.08%), and 4 patients discharged without medical advice(3.39%).6) The distribution of nosocomial infection pathogenic site:Analysis the main pathogenesis position of these infectors, lower respiratory infection was the first(account for 62.65%), the second was urinary tract infection(account for 15.66%), and the third was abdominal cavity(account for 6.02%).7) Among 223 strains isolated from the infectors, the percentage of gram native(G—) bacteria, gram positive(G+) bacteria and fungi were 73.55%(164/223),12.12 %(27/223) and 14.36%(32/223)respectively. Acinetobacter baumannii was the major isolated bacteria among G—strains(32.74%,73/223), and the detectable rates of Pseudomonas aeruginosa and Klebsiella pneumoniae were 16.59%(37/223) and 7.17%(16/223) respectively.8) The most common pathogens of lower respiratory and abdominal cavity infections were G—bacteria, and the most common pathogens of urinary tract infection was fungi.9) The resistant rates of Acinetobacter baumannii to Cefotaxime, imipenem, meropenem, Cefepime and ceftazidime were 100%,98.61%,98.59%,98.04% and 97.06% respectively.10) In the single factor conditional logistic regression analysis,14 risk factors were selected. In the multiple factors condition logistic regression analysis,5 risk factors which were artificial airway, surgery, urinary catheter, arteriovenous catheter, and, combined use of antibiotic were selected.CONCLUSION Nosocomial infections in the Intensive Care Unit were so common that it is very important to prevent and control hospital infection. Lower respiratory infection is the first easily infected pathogenic site. The pathogens of nosocomial Infections are so many, are quite different in different sites. There are many risk factors contribute to nosocornial infection. The medical personnel should strengthen the administration of invasive procedures, and the cleaning of the wards.
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