摘要
目的分析某三级医院医院感染死亡病例特点,为医疗机构有针对性制定医院感染管理决策提供参考。方法回顾性分析某三级教学医院2022年全年的死亡病例医院感染情况,包括疾病诊断相关分组(DRG)及医院感染部位、感染病原菌及耐药性、危险因素和经济负担。结果死亡病例医院感染发生例次率为9.8%,以下呼吸道感染和血流感染为主;死亡病例数前三位的DRG是GB11、RR13和BK19;医院感染死亡病例共分离病原菌51株,检出率最高的是革兰阴性菌,共分离34株,占比为66.7%,革兰阳性菌分离出9株,占比为17.6%,真菌分离出8株,占比为15.7%;住院天数>15 d、抗菌药物使用>20 d、使用呼吸机、糖尿病以及心血管疾病是医院感染死亡的危险因素;医院感染死亡病例较非医院感染死亡病例住院时间和住院费用分别增加了21.5 d和97801.7元。结论医院感染防控工作应密切关注食管和胃肠手术后患者、急性白血病患者,重点监测下呼吸道感染和血流感染的发生,需特别警惕CRKP感染造成的高致死率和高耐药率。
OBJECTIVE To analyze the characteristics of the death cases with nosocomial infection in a tertiary hospital so as to provide bases for medical institutions to put forward targeted measures for management of nosocomial infection.METHODS The status of nosocomial infection among the death cases in a tertiary teaching hospital in the whole year of 2022 was retrospectively analyzed,including disease diagnosis related grouping(DRG),nosocomial infection sites,pathogens causing the infection,drug resistance,risk factors and economic burden.RESULTS The case-time incidence rate of nosocomial infection was 9.8%among the death cases,and the death cases with lower respiratory tract infection and bloodstream infection were dominant.GB11,RR13 and BK19 ranked the top 3 DRG of the death cases.Totally 51 strains of pathogens were isolated from the death cases with nosocomial infection,34(66.7%)of which were gram-negative bacteria,9(17.6%)were gram-positive bacteria,and 8(15.7%)were fungi.Length of hospital stay more than 15 days,use of antibiotics more than 20 days,use of ventilator,diabetes mellitus and cardiovascular diseases were the risk factors for the death of the nosocomial infection cases.As compared with the death cases without nosocomial infection,the length of hospital stay of the death cases with nosocomial infection was increased by 21.5 days,and the hospitalization cost was increased by 97801.7 yuan.CONCLUSION The prevention and control of nosocomial infection should be stressed on the patients undergoing esophageal and gastrointestinal surgeries and the acute leukemia patients,it should focus on the emergence of lower respiratory tract infection and bloodstream infection and remain vigilant with the high lethality rate and high drug resistance rate caused by CRKP infection.
作者
杨俊林
李凌竹
查筑红
杨曦
陈敏
程敏
李晶晶
吴丽萍
YANG Jun-lin;LI Ling-zhu;ZHA Zhu-hong;YANG Xi;CHEN Min;CHENG Min;LI Jing-jing;WU Li-ping(Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550004,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第18期2817-2821,共5页
Chinese Journal of Nosocomiology
基金
贵州省教育厅高等学校自然科学研究项目(黔教技[2024]104号)
贵州医科大学附属医院博士科研启动基金(gyfybsky-2023-29)。
关键词
医院感染
死亡病例
疾病诊断相关分组
耐碳青霉烯类肺炎克雷伯菌
危险因素
经济负担
Nosocomial infection
Death case
Disease diagnosis related grouping
Carbapenem-resistant Klebsiella pneumoniae
Risk factor
Economic burden
