1168例医院感染患者病原菌的调查及其影响因素的探讨

医院感染发病率较高且易于引起医患纠纷。为了解影响医院感染的主要因素及其主要病原体，对陕西省宝鸡市第二人民医院2002—2007年1168例医院感染患者进行了病原菌分离、鉴定及分析，同时对患者基础疾病及感染部位与医院感染的关系进行了探讨。实验结果表明，在临床各科室中，ICU患者医院感染比例（40．6％）最高（P〈0．01），其次为烧伤科（13．3％）、泌尿外科（10．6％）和血液科患者（8．2％）（P〈0．05）。下呼吸道是最为常见的感染部位（33．9％，P〈0．01），其次为泌尿道、胃肠道、手术切口、烧伤创面和血液（10．3％～14．7％，P〈0．05）。1168例医院感染患者标本中，病原菌总阳性率为67．3％（786／1168）。786株病原菌中，革兰阴性菌所占58．7％、革兰阳性菌占26．4％、真菌占14．9％。所分离的革兰阴性菌中，以铜绿假单胞菌（16．9％）、克雷伯菌（15．2％）和大肠埃希菌（11．7％）最为常见。所分离的革兰阳性菌中，以金黄色葡萄球菌（9．3％）和表皮葡萄球菌（7．2％）最为常见。

Investigation of Pathogenic Microbes from 1 168 Patients of Nosocomial Infections and the Approach of Their Influential Factors of the Infections

Nosocomial infections have high morbidity and easily cause disputes between doctors and patients. In order to understand major influencing factors and pathogenic microbes of nosocomial infections, 1 168 pathogenic microbes from nosoeomial infection patients were isolated during 2002 - 2007 in the hospital. Correlations among basic diseases and infection positions of the patients and the generation of nosocomial infections were also investigated. The results indicated that nosocomial infection ratio of the patients from ICU （40.6%） was the highest （P 〈 0.01 ） , and followed by patients from Burn Department （13.3%） , Urinary Surgery （10.6%） and Hematological Department （8.2%） （P 〈 0.05） , as compared with those from all the other clinical departments. Among the nosoeomial infections, lower respiratory tract was the most common infection positions （33.9% , P 〈 0.01 ）, then was urinary tract, gastrointestinal tract, operative incision, burn wound, and blood stream （ 10.3% - 14.7% , P 〈 0.05 ）. Of the samples from 1168 patients, the total positive isolation rate of pathogenic microbes was 67.3% （786/1 168） , 58.7% , and 26.4% ; and 14.9% of the 786 microbial strains were identified as Gram-negative, Gram-positive bacteria, and fungi respectively. Of the 786 microbial strains, the prevalent Gram-negative bacteria were Pseudomonas aeruginosa （ 16.9% ） , Klebsiella spp. （ 15.2% ） , and Escherichia coli （ 11.7% ）, while the dominant Gram-positive bacteria were Staphylococcus aureus （9.3%） and Staphylococcus epidermidis （7.2%）.