| Background and purposeNosocomial infections are infections which are results of treatment in the hospital. Infections are considered nosocomial if they occurred during hospitalization or acquired in hospital but appeared after discharge, not including the infections existed before hospitalization. In addition, Hospital staff's infections acquired in the hospital are also considered as nosocomial infections. Nosocomial infections have attracted much attention. In England, the hospital spend about ten million pounds per year in the study of nosocomial infections, and the Centre for Disease Control and Prevention (CDC) of the United States has been on the constant prospective surveillance, monitoring of the development trend of nosocomial infections and studying constantly on the issues identified from the survey. At the same time, the U.S. CDC puts forward procedures for the prevention and control of nosocomial infections, while also organizes the implement. China in 2001, the incidence rate of nosocomial infections was 5.2% and 4.8% in 2003, 4.8% in 2005. Figures show that the control of nosocomial infections in China has made great achievements after years of efforts. Now medical technology is undergoing rapid change, at the same time, the complicated changes of the transmission of nosocomial infections, susceptible populations and the pathogens have taken place. Therefore, the long-term surveillance of nosocomial infection requires ongoing, in order to understand the trend and dynamic distribution of nosocomial infections accurately. The effective preventive measures are carried out after accessing to accurate information of nosocomial infections timely through surveillance, in order to prevent and control the incidence rate of nosocomial infections. Patients in different hospitals have different characteristics. This study is carried out in a comprehensive local hospital, the main source of which is community groups characterized by older. There will be less critically ill patients and less difficult cases compared with the large hospital. Currently, community groups as the main source of outbreaks, the incidence of nosocomial infection are also a lack of systematic investigation. For this reason, this study aimed through the detailed investigation and analysis on the hospital infections cases, pathogen distribution and antimicrobial spectrum of nosocomial infection in a local hospital of Guangzhou Medical College from November 2007 to October 2009 to improve the overall awareness and understanding to the situation of nosocomial infections, provide a scientific proof for the prevention and treatment of infection and improve health care quality.Methods1. Statistical methodsThe retrospective investigation carried out basing on the hospital's medical records during 2007.11-2009.10 was carried out, with the collection of basic information, disease information, drug use, nosocomial infection diagnosis, pathogens and drug-sensitive case information of all hospital patients. The diagnosis of nosocomial infection based on the medical records from doctors and the monitoring data from the hospital infection control Department. Moreover the incidence of hospital infection, disease position, department distribution and the distribution of pathogenic bacteria were analyzed by using SPSS 13.0 and EXCEL8.0 . 2. Isolation and identification of pathogensThe clinical samples were cultured according to Microbial Laboratory Procedures,while bacterial identification and antimicrobial susceptibility test were conducted using the United States MicroSan WalkAway40 SI automated microbial identification / susceptibility testing system and the KB method. The drug sensitive paper and board using in KB method were purchased from OX Company, and the results were determined according to CLSI standards. The quality control strains were using Escherichia coli ATCC25922, Staphylococcus aureus ATCC25913, Pseudomonas aeruginosa ATCC27853 and ESBLs-positive control strains of Klebsiella pneumoniae ATCC700603. The detection of extended-spectrumβ-lactamase producing bacteria was judged according to the 2005 Committee for Clinical Laboratory Standards (NCCL).ResultsThere were 328 cases of nosocomial infection among 21567 cases of hospitalized patients from November 2007 to October 2009. Through the statistical research, the infection rate was 1.52%, infection in patients with sub-379 cases, case infection rate was 1.76%, the incidence density rate was 1.84‰; the major site was respiratory tract infections accounted for 54.09%, followed by the urinary tract accounted for 21.11%; the incidence rate of disease and incidence density rate of elderly groups were the highest, respectively 8.47% and 3.92‰; hospitalization time was longer as the incidence rate of nosocomial infections was higher, while incidence density changed little. The incidence rate and density rate of departments were the highest respectively 22.11% and 16.38‰in intensive care unit. Most pathogens were gram-negative bacilli accounting for 63.59% for 241 cases detection, E. coli (31.95%), Klebsiella pneumoniae (19.50%), Pseudomonas aeruginosa (17.84%) would be often found. At the same time, 82 Gram-positive bacteria strains were detected accounted for 21.64%. The common Gram-positive bacteria were Staphylococcus aureus (39.02%), coagulase-negative staphylococci (35.37%); fungi detected in 38 strains accounted for 10.02%. Susceptibility results showed that Gram-negative bacteria to imipenem, amikacin sensitivity rate was 80% ,while thesensitivity rate to penicillin class was less than 30%; Gram-positive cocci to vancomycin and linezolid sensitivity was 100%. Currently vancomycin and linezolid resistant strains haven't been found, ant the rate of resistant to ampicillin and penicillin was more than 90%.ConclusionsIntensive care unit, cancer division and respiratory division, which hospitalization time was longer and hospital infection rates and incidence density were higher, were the focal point monitoring objectives. Major pathogens of nosocomial infections was Gram-negative bacteria, and clinical treatment should be based on the rational use of drug sensitivity test , to reduce fungal infections and drug resistance, in order to prevent and control nosocomial infections effectively and shorter hospitalization timing.
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