Investigation On Nosocomial Infection Of Neurosurgery In A Grade Ⅲ Level A Hospital From 2014 To 2018

Objective:,The purpose of this thesis is to provide reference basis for the prevention and treatment of nosocomial infections,the prediction of bacterial resistance,and the rational use of antibacterials,through the analysis of the distribution and drug resistance of pathogenic bacteria of neurosurgery hospital infection of a Grade III Level A hospital from2014 to 2018.Through the study of risk factors that may increase the infection of multiple pathogens in the hospital,this thesis provides a reference for the choice of treatment methods and the precautions during the process of clinical diagnosis and treatment.Methods:With the LIS system,the data of 899 patients who were admitted to neurosurgery department and detected pathogens from January 1,2014 to December 31,2018 in a Guizhou-based Grade III Level A hospital was reviewed and retrospectively analyzed.The survey included patients’personal information,surgical conditions,imaging and laboratory findings.According to the Diagnostic Criteria for Nosocomial Infections(Trial)issued by the Ministry of Health in 2001,patients meeting the requirements of nosocomial infection were screened out.The information of pathogenic bacteria types,drug resistance,and specimen collection sites in infected patients were reviewed through the LIS system,and?~2 test was used for analysis.The age,operation time,number of operations,stay in ICU,length of stay in hospital,invasive operation outside the surgery,and the number of white blood cells before operation or invasive operation of infected patients were consulted by Jiahe Electronic Medical Record System.The test method was selected according to the data type.The test benchmark a=0.05,P<0.05 difference was statistically significant.The factors with statistical significance were included in the binary logistic regression model.The risk factors of multi-pathogenic bacteria infection were analyzed by SPSS 20.0 software.Results:(1)From 2014 to 2018,a total of 9,186 patients were admitted to the neurosurgery of this hospital.Among them,351 patients had nosocomial infection and detected pathogenic bacteria.The infection rate of nosocomial pathogenic bacteria was3.82%,mainly respiratory tract infection,which accounted for 52.64%of the total number of nosocomial infection pathogens,followed by urinary tract infections,accounting for17.31%.A total of 556 pathogenic bacteria were detected in 351 patients,of which 69.78%(388/556)were Gram-negative bacteria,28.24%(157/556)were Gram-positive bacteria,and 1.98%(11/556)were fungi.(2)From 2014 to 2018,the top five pathogens of infected inpatients in neurosurgery were Klebsiella pneumoniae(KP)19.78%(110 cases),Escherichia coli(EC)14.75%(82 cases),Staphylococcus aureus(SA)13.85%(77 cases),Acinetobacter baumannii(AB)13.67%(76 cases),and Pseudomonas aeruginosa(PE)8.27%(46 cases).(3)From 2014 to 2018,the infection rate of the top five nosocomial infection pathogens in this hospital showed a downward trend.The nosocomial infection rate of SA in 2017 was0.52%,which was lower than 1.62%in 2014 and had statistical significance(P<0.005).The nosocomial infection rate of PE in 2018 was 0.24%,which was lower than 1.00%in2014 and had statistically significant(P<0.005).(4)Multi-drug resistance of the top five nosocomial infection pathogens in this hospital from 2014 to 2018:The detection rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)showed an upward trend with statistical significance(P<0.05).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)showed a downward trend with statistical significance(P<0.05).The other bacteria showed no statistical significance during these years.(5)The risk factors for nosocomial infection of multiple pathogenic bacteria in neurosurgery of this hospital were:invasive operation outside the surgery(OR=4.89),operation time(OR=4.24),increased white blood cell count before operation or invasive operation or increased C-reactive protein(OR=1.76)and admission to ICU(OR=1.68).Conclusions:(1)The nosocomial infection of hospitalized patients in neurosurgery of this hospital is mainly Gram-negative bacteria,and respiratory tract is the main site of infection.KP infection rate is the highest,and the detection rate of CRKP is increasing year by year.Therefore,the infection of CRKP in lungs is worthy of attention.(2)The main risk factors for nosocomial infection of multiple pathogenic bacteria in neurosurgery of the hospital are:invasive operation outside the surgery,operation time,increased white blood cell count before operation or invasive operation or increased C-reactive protein,and admission to ICU.