2012年全国医院感染现患率与横断面抗菌药物使用率调查报告

China national point prevalence survey on healthcareassociated infection and antimicrobial use in 2012

摘要:

目的调查不同规模医院的医院感染（HAI）及社区感染（CAI）现患情况。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2012年参加调查的各医院住院患者的日HAI和CAI现患率、抗菌药物使用情况及病原学送检率。结果共调查1 313 家不同规模医院，786 028例住院患者，发现25 273例医院感染病例，HAI现患率为3.22%；177 009例CAI病例，CAI现患率为22.52%。301 770例患者使用抗菌药物，抗菌药物使用率为38.39%，治疗用药患者中40.16%送标本做细菌培养检测。床位数＜300、300～599、600～899、≥900的不同规模医院HAI现患率和病原送检率呈“阶梯式”升高(HAI现患率分别为2.11%、2.52%、3.49%、3.91%；病原学送检率分别为23.43%、33.97%、45.38%、49.05%，差异有统计学意义)。CAI现患率和抗菌药物使用率则呈“阶梯式”降低（CAI现患率依次为28.99%、25.43%、21.97%、18.72%；抗菌药物使用率依次为46.58%、41.14%、37.23%、34.64%，差异有统计学意义）。HAI现患率居前5位的科室分别是综合重症监护室（ICU，27.76%）、血液科（10.13%）、烧伤科（9.64%）、神经外科（9.00%）、儿科新生儿组（5.34%）。HAI病例共分离病原体12 447株，居前5位者分别为铜绿假单胞菌（1 825株）、大肠埃希菌（1 750株）、肺炎克雷伯菌（1 437株）、鲍曼不动杆菌（1 321株）、金黄色葡萄球菌（1 112株）。结论HAI现患率在下降，ICU 的HAI现患率最高；革兰阴性细菌仍是HAI主要病原体；与以往相比，抗菌药物使用率明显降低，病原学送检率明显增高。

Abstract:

ObjectiveTo investigate point prevalence of healthcareassociated infection(HAI) and communityassociated infection(CAI) in hospitals with different scales.MethodsAccording to the unified arrangement of National HAI Surveillance System, crosssectional survey was adopted to investigate daily HAI and CAI rate, antimicrobial use, and specimen detection rate in hospitals participated in the survey in 2012. ResultsOn the survey day, a total of 786 028 patients in 1 313 hospitals were investigated, of whom 25 273 (3.22%) had HAI, and 177 009(22.52%) had CAI, 301 770 (38.39%) were prescribed antimicrobial agents. Among patients prescribed antimicrobial agents for therapy, 40.16% had their specimens sent to the laboratory for bacterial culture. Among hospitals with＜300,300-599,600-899, and ≥900 beds,prevalence rate of HAI (HAIR) and bacterial culture rate(BCR) had a “stepbystep” rise (HAIR：2.11%，2.52%，3.49%，3.91%; BCR: 23.43%,33.97%,45.38%, 49.05%, the difference was statistically significant);prevalence rate of CAI (CAIR) and antimicrobial use rate(AUR) had a “stepbystep” decrease (CAIR：28.99%，25.43%，21.97%，18.72%；AUR： 46.58%，41.14%，37.23%，34.64%,the difference was statistically significant). The top five departments with highest prevalence rate were intensive care unit (ICU,27.76%), hematology (10.13%), burn (9.64%),neurosurgery（9.00%）,and neonatology division of pediatric department（5.34%）. A total of 12 447 pathogens were isolated from patients with HAI, the top five bacteria were Pseudomonas aeruginosa（1 825 isolates）, Escherichia coli（1 750 isolates）, Klebsiella pneumoniae（1 437 isolates）, Acinetobacter baumannii（1 321 isolates）, and Staphylococcus aureus（1 112 isolates）.ConclusionPoint prevalence rate of HAI has decreased compared with previous, ICU has the highest HAI prevalence rate; gramnegative bacteria are main pathogens of HAI; AUR is lower than before, and the BCR increased obviously.