2019—2023年某地某三甲中医医院医院感染临床特征分析

摘要/Abstract

摘要： 目的分析2019—2023年某地某三甲中医医院医院感染临床特征。方法回顾性收集2019—2023年泰安市中医医院院感监测数据,分析医院感染情况、医院感染漏报情况、抗菌药物使用情况、Ⅰ类切口手术部位感染率及预防性抗菌药物使用率、多重耐药菌感染情况、三管相关感染发病情况、医院感染部位和科室情况分布特征等。结果 2019—2023年全院住院总人数为168 413人,医院感染人数为1 626人,感染发病率为0.97%,医院感染例次数为1 757例次,感染率为1.04%。漏报人数为27人,漏报率为1.66%,漏报例次数为27例次,漏报率为1.54%。多重耐药菌感染人数为198人,感染率为0.12%,感染例次数为226例次,感染率为0.13%。抗菌药物使用人数为68 301人,使用率40.56%。Ⅰ类切口手术患者为8 900人,手术例数为9 432例,手术部位感染例数14例,感染率为0.16%。抗菌药物预防用药例数4 606例,预防使用率48.83%。导尿管插管人数为13 821人,总天数为127 026 d,导尿管相关感染人数为275人,感染例次为277例,感染率为2.18‰;中央血管导管使用人数为1 168人,总天数为12 832 d,中央血管导管相关感染人数为6人,感染例次为6例,感染率为0.47‰。总共有1 757例次医院感染,其中前5位是下呼吸道感染（含呼吸机相关）、泌尿系感染（含尿管相关）、上呼吸道感染、菌血症（含中央血管导管相关）、胃肠道感染,分别占38.82%、26.24%、21.63%、3.70%和2.22%。医院感染居前5位是脑病科（含脑病监护室）、重症医学科、康复科、脑病外科、老年病科,分别占23.33%、19.52%、7.63%、7.40%、6.49%。总共有226例次多重耐药菌医院感染,多耐药菌感染居前5位的科室分别是重症医学科、脑病外科、康复科、脑病科（含脑病监护室）、老年病科,分别占57.08%、12.39%、7.96%、7.08%、7.08%。发病率最高的病原体为碳青霉烯类耐药鲍曼不动杆菌。发病率最高的部位为下呼吸道感染（含呼吸机相关）和泌尿系感染（含导尿管相关）,分别为76.99%和10.18%;多重耐药菌感染送检标本以痰液为主,其次是尿、穿刺液和分泌物以及血标本。结论医院感染发病率、漏报率以及Ⅰ类切口手术感染率等指标均达标,但住院患者抗菌药物情况以及针对多重耐药菌的监测和防控措施的落实,仍是今后医院感染管理工作的重点和难点环节。

关键词: 医院感染, 感染率, 抗菌药物, 多重耐药菌

Abstract: Objective To analyze the clinical features of nosocomial infection in a top three Chinese medicine hospital from 2019 to 2023. Methods The monitoring data of hospital feeling in Tai 'an Hospital of Traditional Chinese Medicine from 2019-2023 were collected retrospectively. The situation of nosocomial infection, underreporting of nosocomial infection, use of antibiotics, infection rate of Class Ⅰ incision and prophylactic antibiotics, multi-drug-resistant bacteria infection, incidence of three-tube related infections, distribution characteristics of nosocomial infection sites and departments were analyzed. Results From 2019 to 2023, the total number of inpatients in our hospital was 168 413, the number of nosocomial infections was 1 626, the incidence of infection was 0.97%, the number of nosocomial infections was 1757, and the rate of infection was 1.04%. The number of missed reports was 27, with a false report rate of 1.66%, and the number of missed reports was 27, with a false report rate of 1.54%.The number of multidrug-resistant bacteria was 198, the infection rate was 0.12%, the number of infection cases was 226, the infection rate was 0.13%. The number of users of antibiotics was 68 301 (40.56%). There were 8900 patients with Class Ⅰ incision surgery, 9 432 cases of operation, 14 cases of surgical site infection, and the infection rate was 0.16%. There were 4 606 cases of antibiotic prophylactic use, and the prophylactic use rate was 48.83%. The number of catheterization patients was 13 821, the total number of days was 127 026, the number of catheter-related infections was 275, the number of infections was 277, the infection rate was 2.18‰. The number of users of central vessel catheters was 1 168, the total number of days was 12 832, the number of central vessel catheter-related infections was 6, the number of infections was 6, and the infection rate was 0.47‰. There were a total of 1 757 nosocomial infections, among which the top 5 were lower respiratory tract infections (including ventilator-related infections), urinary tract infections (including urinary duct related infections), upper respiratory tract infections, bacteremia (including central vascular catheter-related infections) and gastrointestinal infections, accounting for 38.82%, 26.24%, 21.63%, 3.70% and 2.22%, respectively. The top 5 nosocomial infections were in the department of encephalopathy (including the ICU), the Department of intensive Care Medicine, the department of rehabilitation, the department of encephalopathy surgery and the Department of geriatrics, accounting for 23.33%, 19.52%, 7.63%, 7.40% and 6.49% respectively. A total of 226 cases of multidrug-resistant bacteria were nosocomial infections, and the top 5 departments of multidrug-resistant bacteria infection were intensive care medicine, encephalopathy surgery, rehabilitation, encephalopathy (including encephalopathy ICU), and geriatrics, accounting for 57.08%, 12.39%, 7.96%, 7.08%, 7.08%, respectively. The pathogen with the highest incidence was carbapenem-resistant Acinetobacter baumannii. The highest incidence sites were lower respiratory tract infection (including ventilator related) and urinary tract infection (including catheter related), 76.99% and 10.18%, respectively. Sputum, urine, puncture fluid and secretions and blood samples were the main samples for multidrug-resistant bacterial infection. Conclusion The incidence rate of nosocomial infection, the missing report rate and the infection rate of class Ⅰ incision are all up to standard. However, the situation of antibiotics in inpatients and the monitoring and prevention measures of multi-drug-resistant bacteria are still the key and difficult link in the management of nosocomial infection in the future.

Key words: hospital infection, infection rate, antimicrobial drugs, multi-drug resistant bacteria

中图分类号:

R181.3+2

孔衍琳, 曹怡. 2019—2023年某地某三甲中医医院医院感染临床特征分析[J]. 中华养生保健, 2025, 43(7): 15-20.

KONG Yan-lin, CAO Yi. Analysis of Clinical Characteristics of Nosocomial Infection in a Grade A Tertiary Chinese Medicine Hospital from 2019 to 2023[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(7): 15-20.

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