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目的:分析某三级中医院医院获得性血流感染(n BSIs)的流行病学和病原学特征,探索影响28天病死率的相关危险因素。创新点:纳入2009~2011年所有确诊的血流感染病例,而非只依靠血培养结果做判定。收集包括患者的基础性疾病、侵入性操作等感染相关危险因素、标本送检及抗菌药物使用情况等全面的临床资料,分析了n BSIs的发生率、病区分布、人群分布、病原体分布、细菌耐药性及病死率,并对影响死亡的危险因素进行了多因素分析。方法:采用回顾性调查的方法,从病历资料中获得预先设置好的相关信息。病原体的分离鉴定和药敏检测由医院微生物实验室专职人员完成。使用WHONET5.6软件对药敏结果进行分析。采用SPSS 16.0对所有数据进行统计分析,死亡危险因素判定先用单因素分析,再用多因素Logistic回归分析。结论:某三级中医院n BSIs的发生率为5.7/1000入院人数,大肠埃希菌和凝固酶阴性的葡萄球菌(Co NS)是检出最多的两种细菌。约有1/3的肠杆菌对第三代头孢菌素耐药(表4),90.7%的Co NS对甲氧西林耐药(表3)。碳青霉烯类和糖肽类是用于治疗n BSIs使用最广泛的两类抗生素(图1)。感染性休克、血液透析、Pitt菌血症得分>4和尿路感染是28天死亡的危险因素,而合理的经验性用药可以明显改善预后(表6)。
OBJECTIVE: To analyze the epidemiological and etiological characteristics of hospital acquired nosocomial bloodstream infections (nBSIs) in a tertiary hospital and to explore the relevant risk factors affecting the 28-day mortality rate. Innovation: Including 2009 to 2011, all confirmed cases of bloodstream infections, rather than just rely on blood culture results to make the decision. We collected comprehensive clinical data including patient’s underlying diseases, infection-related risk factors such as invasive procedures, specimen submission and use of antimicrobial agents. The incidence of n BSIs, ward distribution, population distribution, distribution of pathogens, Drug resistance and mortality, and multivariate analysis of the risk factors affecting death. Methods: A retrospective survey method was used to obtain the pre-set relevant information from the medical record data. Pathogen isolation and identification and susceptibility testing by the hospital microbiology laboratory full-time staff to complete. Use WHONET5.6 software to analyze susceptibility results. All data were analyzed by SPSS 16.0. The risk factors of death were analyzed by univariate analysis and multivariate logistic regression analysis. CONCLUSIONS: The incidence of n-BSIs was 5.7 / 1000 in a tertiary hospital and Escherichia coli and coagulase-negative staphylococci (Co NS) were the two most frequently detected. Approximately one-third of Enterobacteriaceae were resistant to third-generation cephalosporins (Table 4) and 90.7% of Co NS were resistant to methicillin (Table 3). Carbapenems and glycopeptides are the two most widely used classes of antibiotics used to treat n BSIs (Figure 1). Septic shock, hemodialysis, Pitt bacteremia score> 4, and urinary tract infection were risk factors for 28-day mortality, whereas reasonable empirical medication improved outcomes significantly (Table 6).