| BackgroundPathogenic microorganisms infectious disease is one of the most common human diseases. According to the location of infection, the infection can be divided into communities (Community-acquired Infection, CAI) and hospital infections (Hospital Infection, HI).Hospital infections (HI) also called nosocomial infections, is the inpatient hospital-acquired infections, including infections and infections in the hospital after the discharge obtained during hospitalization, but prior to the start time of admission or admission excluding in the incubation period of the infection. Hospital staff in the case of hospital-acquired infections are also called hospital infections. With the advances in modern medicine levels, plenty of antibacterial drugs in the clinical variety of invasive procedures, tests, treatments gradually increased the opportunity to enter the body of the bacteria causing the infection. Hospital infections seriously affecting the health and lives of patients hospitalized due to nosocomial infections in hospital for a few days so that the patient’s increased mortality, to patients, relatives, social and health insurance agency has brought pressure to make overwhelmed. With the change in disease spectrum of hospital infection, its refractory and high morbidity, high mortality rate makes reducing hospital infection rates have become a new topic of today’s research.Community infections (CAI), also known as community-acquired infections, patients before admission and admission to get in the incubation period of the infection within48h or. addition to nosocomial infections Infection is a major part of the community of infectious diseases, including upper respiratory tract infections, lower respiratory tract infections, urinary tract infections, bacteremia, skin and soft tissue infections and central nervous system infections.In recent years, most of the antimicrobial agents are applied in the treatment of infections in the community, according to the foreign reports, application of antibacterial drugs in the community hospital is five times higher than the hospital. Our community use of antibiotics empirically blind medication is relatively common, difficult to manage and control, but also the lack of drug monitoring data. In recent years, a new community of resistant strains emerging, not only the existence of community-acquired methicillin-resistant bacteria Staphylococcus also detected in producing extended-spectrum β-lactamases of Gram-negative bacteria and is a multi-drug resistant. Overall, community-acquired pathogens showed an increasing trend, growing bacterial resistance, anti-infection treatment for clinical raised new challenges.At present the domestic and foreign various drug resistance monitoring network for hospital infection surveillance, and community-acquired infections is less monitoring data. Therefore, investigation and analysis of community-acquired status quo, comparing hospital infection and the distribution of community-acquired pathogens, bacterial resistance, the number of hospital days due to infection and prolonged, it takes more than hospitalization costs, among other factors, to community-acquired and hospital infection control and clinical provide the basis for treatment is important.ObjectiveWe collected the general characteristics of a Shandong hospital patients infected with community-and hospital-infected persons, the distribution of pathogens, antimicrobial drug resistance, the hospital days due to infection, such as the extension of the data, the community and hospital infections were infected infection comparative analysis between features, provide the basis for future clinical treatment and prevention of infection, In this study may also provide basic data for the management of community infections department.Methodsl.The object of study:January1,2012to December31,2013hospitalized patients in Shandong Provincial Hospital (West Temple).2.Determination of sample size:The current situation of the sample size is calculated based on the expected prevalence of hospital infection P=2%, the estimated sample size using the following formula. n=zα2/d2*pq where p is expected nosocomial infection prevalence; q=1-p;d is the tolerance, the general d=0.1*p; Za as a significant test statistic when, a=0.05, Za=1.96; n is the sample size, In this study the sample size n was calculated to19,600people, the number of cases studied37,070people found the sample volume requirement.3.Statistical analysis:Community-acquired and hospital infections characterized by relatively gender, infection distribution Segment information department inspection, the number of days of hospitalization numeric data using Mann-Whitney test. Factors affecting the number of days of hospitalization analysis, univariate analysis using rank correlation analysis (Wilcoxon W or Kruskal-Wallis test) and multivariate analysis using generalized linear regression model. Data were analyzed using SPSS20.0, two-sided test, test level of a=0.05.Results1. Specimen Distribution:The community and hospital infections distribution has statistically significant (X2=131.329, P<0.001), The except for the first two sputum specimens results showed the mosr significantly different between two group. And the ear canal infected secretions specimens in the community accounted for a larger proportion (28.98%), Besides the above specimens, the hospital infection occupied in a large proportion (37.41%).2. Infection Distribution:Between1January2012to31December2013, there were37,070cases of hospital patients, in which735cases were collected from community-acquired and the infection rate is24.26‰;278cases were collected from the hospital in which the infection rate was9.18‰.3.Gender Distribution:CAI and HI by gender composition have the statistically significant (X2=5.606,P=0.018), HI have a higher proportion of men than the community infection.4.Age distribution:CAI and HI infections by age composition have the statistically significant (X2=75.623,P<0.001), The CAI patients ranged from50to60years accounted for the largest (15.23%) proportion; The HI patients ranged from60to70years has the maximum proportion (25.18%).5.Sections Distribution:CAI and HI among hospitalized departments exist statistically significant differences in infection rates (X2=340.693, P<0.001), the former community infection five departments were otology (80.33‰), respiratory medicine (70.54‰), integrated medicine (45.92‰), Pediatrics (37.94‰) and Cardiovascular Medicine (27.70‰). Pre-hospital infection rates five departments were acupuncture and physiotherapy department (36.71‰), respiratory medicine (21.44‰), neurosurgery (21.28‰), Throat-Head and Neck Surgery (20.95‰) and general surgery (12.82%o).6.Distribution of infection sites:CAI and HI by the distribution of the infection site was significantly (X2=240.540, P<0.001), community-acquired infection site who in turn among the top three were respiratory (50.20%), ear, nose Chronic inflammation of the throat Ophthalmology (33.33%), and genitourinary system (10.75%); hospital infection who ranks three former site of infection in turn were respiratory (54.32%), surgery and incision infection (21.22%), and genitourinary system (9.71%).7.Pathogen distribution:Community and hospital infections were detected statistically significant differences in the distribution of pathogens (X2=597.577, P <0.001). Five former community-acquired pathogen Pseudomonas aeruginosa (16.46%), Staphylococcus aureus (14.42%), coagulase-negative staphylococci (12.93%), Escherichia coli (11.97%) and Klebsiella (9.93%). Five former hospital infection pathogen Pseudomonas aeruginosa (19.06%), Escherichia coli (12.59%), Klebsiella (11.15%), Staphylococcus aureus (10.43%) and coagulase-negative staphylococci (9.35%).8.Distribution of drug resistance:Resistance rates of community-acquired Enterobacter top three were ampicillin (84.4%), cefazolin (67.9%), piperacillin (67.6%); non-fermenting bacteria resistant rate The top three were amoxicillin/ clavulanic acid (93.2%), cefotaxime (88.4%), cefazolin (88.2%); aureus resistance rates were ranked the top three ampicillin (93.5%), cefoxitin (91.7%), penicillin (85.8%). Hospital infection rates of Enterobacteriaceae resistant to ampicillin were ranked the top three (90.2%), cefazolin (80.5%), ampicillin/sulbactam (75.0%); non-fermenting bacteria resistant rate the top three The order of amoxicillin/clavulanic acid (89.7%), chloramphenicol (81.8%),ampicillin/sulbactam(80.0%); Staphylococcus resistant rate of the top three were penicillin (90.5%),ampicillin (84.6%), clindamycin (81.8%).9.Days of hospitalization:the main factors that may affect the length of hospital stay were rank correlation analysis (Wilcoxon W or Kruskal-Wallis test), analysis shows that the number of hospital days may be associated with age, occupation, drugs co-ordination methods and sources of infection (community/hospital infection) about; against respiratory infections and non-fermenting E. coli bacteria infected hospital infections prolong16.79days than the number of days of hospitalization community infection; coli infected hospital for urinary tract infections prolong22.47days than the number of days hospitalized community-acquired.Conclusions1. Community-acquired infections and hospital pathogens share the same five most Susceptible bacteria, which are Pseudomonas aeruginosa, Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli and Klebsiella.2. Gentamicin,aztreonam,piperacillin,ampicillin/sulbactam,ciprofloxacin, voriconazole, ceftazidime and amoxicillin/clavulanate resistance rate of HI higher than CAI.3. The hospital stay was related with the age, occupation, drugs co-ordination and infection sources, The hospital stay of HI several days longer than those CAI patients. |
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