Surveillance Of Pathogens From Patients With Hospital Infection And Analysis Of Drug Resistance And Hospital Infection Prevention In Intensive Care Unit

Modern medicine proved that nosocomial infection has become one of the obstacles in successful rescue critically ill patients .Hospital infections can increase hospital costs and extended hospital stay.The mortality rate of patient can be increased also.The serious economic losses have been brought not only to patients but also to the hospital. At present, there are 50 million inpatients per year in China, about 5 million of whom appear Hospital Infection. It causes about 10 billion Yuan extra medical treatment consumes each year. As ICU (intensive care unit, ICU) patients in critical condition, mostly suffering from severe underlying diseases, immune dysfunction, poor defense against infection. The patienst in ICU often have a variety of invasive procedures,and long-term and widespread use of antibiotics, that cause nosocomial infection of multiple drug resistant pathogens easily. Modern medicine proved successful rescue of nosocomial infection in critically ill patients has become one of the obstacles.It was reported that, nosocomial infection can be reduced in 32% through effective monitoring . In order to reduce hospital intensive care unit (ICU) nosocomial infection rate, the implementation of scientific and effective interventions should be taken to prevent the occurrence of nosocomial infection, ICU have become a key departments for hospital infection control at all levels Institutions. The phenomenon of excessive use of antibiotics is growing,which cause serious public health problems of bacterial resistance.The emergence of multi-drug resistant pathogens and pan-drug resistant pathogens has brought great difficulties in controlling the hospital infection and clinical treatment. were analyzed multi-drug resistant infection risk factors of nosocomial infection in ICU,in order to ake comprehensive measures to effective Prevent and control drug-resistant infections.Research Purpose1.To investigate the antibiotic resistance distribution and profiles of multidrug resistant bacteria in intensive care unit ( ICU ).2.Another purpose is to to analyze the related risk factors for multidrug resistant bacterial infections,and to provide medical support for prevention and control of nosocomial infection.Materials and Methods1.General MaterialsFrom January 2009 to December 2010,A total 1202 patients in intensive care unit ,551 cases in 2009,651 cases in 2010. 698 patients were male, female 504 cases;aging from 2 to 93 years, with an average age of 54.15 years, there are 539 patients'age was over 60 year, accounting for 44.84%. A total 142 hospital-acquired infection paitients in intensive care unit from January 2009 to December 2010, 84 cases of multidrug-resistant bacterial infection patients ,and 58 cases of non- multidrug-resistant bacterial infection patients;59 patients were male, accounting for 41.55%, female 75 cases, accounting for 58.45%,aging from 25 to 87 years, with an average age of 62.93 years,there are 94 patients'age was over 60 year, accounting for 66.20%.2.Methods2.1 Prospective surveillance was conducted from Juanuary 2009 to December 2010 to monitor 1202 cases paitients in ICU. The patient was followed up afer transfered out ICU. 2.2 From January 2009 to December 2010,the clinical data of 142 cases of hospital infection patients in ICU were collected .The distribution of pathogens ,drug resistance, and risk factors of multiple drug resistant infection were analyzed retrospectively.2.3 Establish a database with the Excel software .Measurement data were compared with t test between the two groups. The count data were compared with the rate or constitute a description and were analyzed with X2 test, using SPSS 17. O statistical software .It was considered statistically significant to P <0.05. From Juanuary 2009 to December 2010 ,the clinical data which collected 142 cases of hospital infection patients in ICU analyze by binary logistic regression, With binary logistic regression analysis, we let to the regression model of the multidrug-resistant bacterial infection for the patients with nosocomial infection in ICU.Results1.The surveillance data involved 1202 hospitalized patients , of whom 142 had a hospital-acquired infection . In 2010,nosocomial infection rate was 11.52%, the rate of hospital infection daily was 3.03% , catheter associated urinary tract infections Rate was 0.20% , catheter-related bloodstream infection rate of 0.31%. It was come down compared with that of in 2009. The incidence of ventilator-associated pneumonia was approximately same as that of in 2009.2.A toltal of 311 strains were detected from 142 hospital-acquired infection paitients .The lower respiratory tract was the main infection site, which count for 90.18%,followed by urinary-tract infections and catheter-related bloodstream infection. The rate of lower respiratory tract infection in 2010 was higher than that of in 2009. The rate of lower urinary-tract infections and catheter-related bloodstream infection in 2010 was lower than that of in 2009.3.There are 311 pathogen were separated from 142 hospital-acquired infection patients ,many of them come from specimens of phlegm ,its percentage is 74.92%, specimens of blood is 9.65% ,and specimens of urine is 5.79%. 4.In the 311 strains,there were 179 strains of gram negative bacterium which accounted for 57.56% ,88 strains of gram-positive cocci(for28.30%),44 strains of fungus(for 14.15%). In 2010,pathogen increased than that of in 2009 generally. The top six in 311 isolated pathogenic bacteria were Staphylococcus aureus(for18.01%), followed by Acinetobacter Baumannii(for 15.76%), pseudomonas aeruginosa( for 14.15%), candida albican(sfor 7.07%), Escherichia Col(ifor 8.68%), Klebsiella pneumonia(for 5.79%).5.The isolation rate of coagulase-negative methicillin-resistant Staphylococcus aureus, multidrug resistant Pseudomonas aeruginosa, ESBLs producing Klebsiella pneumoniae and E. coli decline in 2010 than that of in 2009., The isolation rate of MRSA and multiple drug resistance Acinetobacter baumannii was same as that of in 2009 roughly.6.The number of multiple drug-resistant strains of Gram-negative bacteria in 2010 decreased slightly compared with that of in 2009. In 2010, the drug sensitivity rate of gram-negative bacilli higher than that of in 2009. Carbapenems was the most active antibiotics for gram negative bacilli, and vancomycin for gram positive cocci.It's worth noting that teicoplanin ,quinoline Nupu Ting / dalfopristin and linezolid resistant strains has been found in 2009.But the drug sensitivity rate of MRSA on the quinoline Nupu Ting / dalfopristin, linezolid have come back up to 100% in 2010.7.Statistical analysis revealed that there is statistically significant difference in the elderly senior citizens ,the time of admition to ICU,the time of mechanical ventilation, the time of urethral catheterization, the time of Venous catheter ,type of using antibiotics drug, multi-drug combination, time of using antimicrobial drugs,Hypoproteinemia,use of Glucocorticoidand complicated Chronic lung disease between two groups of patients with non-multidrug and multidrug resistant bacterial infection. also ( all P < 0.05). Logistic analysis revealed that the time of admition to ICU,type of using antibiotics drug, time of using antimicrobial drugs were independent risk factors form multidrug-resistant bacterial infection ( all P < 0.05). Conclusions1.There is a high frequency of multidrug-resistant bacterial infection in ICU. The elderly senior citizens ,the time of admition to ICU,the time of mechanical ventilation, the time of urethral catheterization, the time of Venous catheter ,type of using antibiotics drug, multi-drug combination, time of using antimicrobial drugs,hypoproteinemia,use of Glucocorticoidand complicated Chronic lung disease were closely related to multidrug resistant bacterial infection.2.It is important to strengthening the monitoring of nosocomial infection and pathogens in ICU. The nosocomial infection can reduce through effective monitoring and prevention. Early prevention, early isolation and early control should be done in cases with multiple antibiotic resistant bacteria. The spread of multiple drug-resistant bacteria in the ICU and within the hospital should be controlled. The prognosis of the patients who are allowed can turn to the common ward as soon as possible. At the same time , reasonable choice of invasive medical operation, try to reduce unnecessary Invasiveness operation to reduce invasive relevant operation rates, thereby reducing the hospital infection rates.