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目的了解贵州省苗族侗族自治州医院医院感染现状,为医院感染防控措施的制定提供依据。方法按照全国医院感染监测网的统一部署,采用横断面调查方法,调查贵州省苗族侗族自治州26所医院医院感染现患率、抗菌药物使用情况及细菌培养送检率。结果共调查3所三级医院、23所二级医院7 799例住院患者,发生医院感染198例、205例次,医院感染现患率为2.54%,例次现患率为2.65%。综合重症监护病房(ICU)医院感染现患率最高,为29.63%;医院感染部位以下呼吸道为主(占44.44%);医院感染病原体以革兰阴性(G-)菌为主,主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌等。抗菌药物使用率为45.66%,二级医院抗菌药物使用率为53.65%,高于三级医院的31.14%(χ2=148.53,P<0.001)。治疗用药占74.02%,预防用药占19.77%,预防+治疗用药占6.21%;抗菌药物单一用药比率占81.02%,二联占17.21%,三联及以上占1.77%;治疗用药及治疗+预防用药患者细菌培养送检率为29.37%。结论该地区医院感染现患率低于全国平均水平,抗菌药物使用率低于国家标准,应加强医院感染重点科室、重点部位的管理,合理使用抗菌药物,尤其是二级医院。
Objective To understand the current status of nosocomial infections in hospitals in Guizhou Miao and Dong Autonomous Prefecture and provide the basis for the establishment of prevention and control measures for nosocomial infections. Methods According to the unified deployment of National Hospital Infection Monitoring Network, the prevalence rate of infection, antimicrobial use and the rate of bacterial culture in 26 hospitals in Guizhou Miao and Dong Autonomous Prefecture were investigated by cross-sectional survey. Results A total of 7 799 hospitalized patients in 3 tertiary hospitals and 23 secondary hospitals were investigated. Among them, 198 were hospital-acquired and 205 were hospitalized. The prevalence of nosocomial infections was 2.54% and the prevalence was 2.65%. The prevalence rate of nosocomial infection in intensive care unit (ICU) was the highest (29.63%), mainly in the respiratory tract (44.44%) in the nosocomial infection sites. Gram-negative (G-) bacteria were the main pathogens in nosocomial infections, Pseudomonas aeruginosa, Klebsiella pneumoniae and the like. The antibacterial usage rate was 45.66%, the secondary hospital antibacterial usage rate was 53.65%, higher than that of tertiary hospitals (χ2 = 148.53, P <0.001). 74.02% for treatment, 19.77% for prophylaxis and 6.21% for prophylaxis and treatment; 81.02% for antimicrobial, 81.21% for two and 1.77% for triple and above; for treatment and treatment plus prophylaxis Bacteria culture delivery rate was 29.37%. Conclusion The prevalence rate of nosocomial infection in this area is lower than the national average level, and the utilization rate of antimicrobial drugs is lower than the national standard. The management of key departments and key parts of nosocomial infections should be strengthened and antibacterial drugs should be used rationally, especially for second level hospitals.