Investigation Of Hospital-acquired Infections And Analysis Of Bacterial Resistance In Three Hospitals Of Tianjin

Objectives:To investigate the prevalence of hospital-acquired infections(HAIs)and the tendency of bacterial distribution and resistance in three representative hospitals of Tianjin in order to prevent and control the hospital-acquired infections and provide useful information for clinical treatment.Methods:The retrospective survey was performed by reviewing the documents for 13688 hospitalized patients of A hospital in 2004,8634 hospitalized patients of B hospital in 2004 and 6099 hospitalized patients of C hospital between 1/1/2005 and 6/30/2005. According to the collected data,the incidences of nosocomial infections,surgical wounds infections of the patients,the ratios in terms of departments and infected sites were respectively calculated.Also,the antibiotic use rates were counted simply.In addition,we have got the message of bacterial distribution and resistance through scrutinizing the records for the infection-causing bacteria during the same period of time.Results:The infected rate in A hospital was the highest one among the three hospitals,which is 6.6%.And the lowest infected rate was 1.9%in B hospital.The infected rate in C hospital was 3.0%.All are lower than the standard published by Ministry of Health of the People's Republic of China(infected rate＜10%).Respiratory tract infection was the leading infection in all the hospitals,following were surgical wound infection in A hospital,the urinary tract infection in B hospital and bloodstream infection in C hospital.The distribution of infected rate in terms of departments was different in each of three hospitals(P＜0.05).Infected rates of general surgical would infections in A hospital,B hospital and C hospital were 4.5%,1.8%,2.7%,respectively.And the infected rates among three type of surgical wound infections were 3.8%ofⅠ,14.8% ofⅡand 19.9%ofⅢin A hospital;1.4%ofⅠ,3.3%ofⅡand 7.0%ofⅢin B hospital;1.8%ofⅠ,1.5 ofⅡand 4.6%ofⅢin C hospital.Infected rates in A hospital and B hospital were consistent with the type of surgical incision.In C hospital,the infected rate ofⅢwas higher than the infected rates ofⅠandⅡ(P＜0.05).And the infected rate ofⅠwas higher than the infected rate ofⅡ,but there was no statistic significance(P＞0.05).About 58.9%inpatients and 92.3%surgical patients in A hospital,84.2%inpatients and 89.2%surgical patients in B hospital and 97.7% inpatients and 98.8%surgical patients in C hospital were treated with antibiotic at least once.The main hospital pathogens were gram negative bacilli.Except the resistant rate of the CNS isolates from C hopstial to Vancomycin was 2.3%,Enterococcus and S. aureus isolated from three hospitals were sensitive to Vancomycin(sensitive rate is 100%).The resistant rates of S.aureus to Oxacillin in A hospital and C hospital were 24.2%and 13.4%,respectively.In B hospital,the resistant rates of E.coli and Klebsiella pneumoniae to Ceftazidime were 72.5%and 57.9%respectively;and the resistant rate of P.Aeruginosa to Ceftazidime was 66.0%,to Imipenem was 66.7%.P. Aeruginosa isolated from C hospital resisted to Ciprofloxacin(resistance rate is 78.6%).All the gram negative pathogens were resistance to Ampicillin with Subactam,resistant rate more than 60%.The resistant rates of gram negative pathogens to Ticarcillin with Clavulani Acid and Amoxicillin with Clavulani Acid were more than 30%.Furthermore,the P.Aeruginosa isolated from C hospital resisted to Amoxicillin with Clavulani Acid,and the resistant rate equals to 100%.Conclusions:Hospital-acquired infected rates in all of three hospitals were lower than national standard.And,the infected rate in A hospital was highest among three hospitals.The ratio in terms of departments was different and respiratory tract infection was most frequent in each of three hospitals,which were accordance with other domestic reports.In A hospital,the surgical wound infection was high due to the basic condition of patents.The rate of antibiotics application was higher than national standard in all of three hospitals.The main hospital pathogens were gram negative bacilli,and most of strains showing resistance to antibiotics were commonly observed, especially multiple antibiotics resistance.In this study,Vancomycin-resistant Enterococcus(VRE)and Vancomycin-resistant Staphylococcus aureus(VRSA)were not observed obviously among three hospitals.The resistant rates of S.aureus to Oxacillin in A hospital and C hospital were lower than the related reports.The resistant rates of E.coli and Klebsiella pneumoniae to Ceftazidime in B hospital were high.In addition,the isolates of P.Aeruginosa from B hospital have a high resistant rate to Ceftazidime and Imipenem.And the isolates of P.Aeruginosa from C hospital were more resistant to Ciprofloxacin.