Surveillance And Investigation On Nosocomial Infection And Distribution And Drug Resistance With Pathogenic Of Hospitalized Children

ObjectiveTo investigate and analyze the characteristic of nosocomial infections and the related factors, and understand the characteristics of the pathogenic bacteria distribution and changes of drug resistance to commonly used antibiotics in hospitalized children of general children’s hospital, so as to provide scientific basis for application of clinical antibiotics and prevent and controll nosocomial infections to reduce hospital infection rates.MethodsMonitoring data of44817hospitalized children with nosocomial infections admitted were retrospectively analyzed in Bayi children’s hospital affiliated to Beijing Military Common Hospital by Hospital Infection Monitoring and Medical Record Management System from Jan2011to Dec2013. To collect all the basic information of the hospitalized children, disease information,the use of antibiotics, diagnosis with hospital infection, information of pathogenic bacteria and change of drug resistance. Cases with hospital infection were diagnosed according to the hospital infection diagnosis standard (trial) that the National Ministry of Health. issued in2001by management personnel of infection control in our hospital. Whether hospital infection of the children occurred in the hospital were confirmed by comprehensive judgement of clinical symptoms, physical signs and laboratory examination.Such as hospital infections occurred many times, indicating infection cases and related information. Sources of strains were from blood, sputum, urine, cerebrospinal fluid, wound secretion, filling lotion of alveolar and gas tube, pleural effusion of2329cases of hospitalized children with nosocomial infections.2579strains of bacteria were obtained. According to the procedures of the national clinical test, bacteria of samples were isolated and cultured. Bacteria identification and drug sensitive experiment of all experimental strain after purification were completed byVITEK-2automatic microbial analyzer (made in bio-Merieux corporate in French) and the quality were controlled by strains of quality control from the National Ministry of Health.According to collected data, to calculate the hospital infection incidence and distribution of the infection site, and analyze the factors related of the hospital infection and distribution characteristics of pathogenic bacteria. Counting rates of drug resistance with pathogenic bacteria and analyze change of drug resistance to commonly used antibiotics.Results1. The rate of hospital infection and the distribution of infection site2329cases were infected with the infection rate of5.2%and the case-time infection rate of6.55%in Bayi children’s hospital.It was higher than the infection rate of4.38%and the case-time infection rate of5.90%.Compared with the infection rate of the whole hospital, the difference was statistically significant (X2=53.52, P<0.01).The infection rates were2.93%,5.02%,8.57%,7.25%respectively in the NICU,PICU, children’s surgical wards and other pediatric ward. Compared with infection rate of different ward, the difference was statistically significant (X2=479.51, P<0.01).In2011-2013, The infection rates were4.91%,5.40%and5.23%,and the case-time infection rates were6.24%,7.06%and6.31%respectively each year.In1-4quarters, the quarterly infection rates were5.45%,5.72%,4.91%,4.79%, and the case-time infection rates were6.76%,7.27%,6.20%,6.05%respectively each quarter. The difference in yearly infection rate shows no statistically significant (X2=3.44, P>0.05), but the difference in quarterly infection rate indicates statistically significant (X2=13.15, P<0.01).The lower respiratory tract ranked the first place, accounted for28.42%. then the hematological system, accounted for20.95%and the upper respiratory tract, accounted for14.45%.2. Monitoring and distribution with pathogen of the hospital infectionIn2935cases of hospital infection, etiology examination of88166cases were at a rate of52.37%.2579pathogens were detected, of which Gram-negative bacteria accounted for64.37%, Gram Gram-positive bacteria accounted for20.05%, fungus accounted for9.81%and other bacteria accounted for5.78%.Among the distribution of infection pathogenic bacteria in2011-2013, Klebsiella pneumoniae,Pseudomonas aeruginosa, Acinetobacter baumannii, E.coli and White Candida were top five.During3years, in the top15infectious pathogens distribution:The gram-negative bacteria accounted for61.81%, the composition ratio were59.28%,67.52%and57.54%respectively.Gram-positive bacteria accounted for18.57%, the composition ratio were21.15%、17.11%and18.18%respectively. Fungi accounted for7.91%. the composition ratio were9.50%、1.22%and9.31%。3. Related factors of hospital infection3.1Distribution of children with gender, age and hospitalization daysAmong the44817cases of hospitalized children, male accounted for61.93%and female accounted for38.07%. The hospital infection rates were5.32%and5.00%respectively.There was no statistically significant difference in infection rates for male and female (X2=2.19,P>0.05).In the age distribution, the hospital infection rate of children under lyear old was5.43%,of which the hospital infection rates of≤28d newborns were3.54%and more than28d to1year old children hospital infection rates were9.92%.1-7years old children hospital infection rates were4.85%, of which the hospital infection rates of1-3and3-7years old were5.38%and4.20%. More than7years old children hospital infection rates were4.42%, among which7-14and>14years old children infection rates were4.57%and3.77%.There was statistically significant difference in nosocomial infection rates for different age group of children (X2=11.02, P<0.01).The average time of all hospitalize children were14.03days in hospital. Children with hospital infection had an average of39.08d in hospital.The number of children hospitalization who were hospitalized<7d,7-14d and>14d accounted for29.73%,36.95%and33.32%. At the corresponding period, their rate of nosocomial infection was0.19%,1.64%and13.61%respectively. The infection rates of different number of days in hospital shows statistical significant (X2=3251.87, P<0.01)3.2Relevant factor of the intrusive operationsIn the group of patients, the hospital infection rate of them who had invasive procedures was8.47%. infection rates of patients with using breathing machine, central vein and urinary tract intubation were4.42%、5.51%and4.51%. The incidence of nosocomial infection of children with surgery was18.89%. The non-invasive procedures incidence of infection occurrence rate was4.16%.Compared the difference of the related infection occurrence rate with the invasive procedures and non-invasive procedures was statistically significant (X2=309.12,P<0.01).3.3The use of antimicrobial agentsThere were34790children to use antimicrobial drugs among the group of cases hospitalized children, utilization rate was77.63%.Annual utilization rate was68.80%,84.44%and78.10%respectively during3years.Nosocomial infection rate of the hospitalized children with using antimicrobial drugs was6.40%and with no using them was1.04%. Compared the difference was statistically significant (X2=453.62, P<0.01)4Pathogen resistance monitoring4.1The drug resistant rate of main gram-negative bacteriaDuring2011-2013, The drugs susceptibility testing results of the main of gram-negative bacteria to commonly used14kinds of55kinds of antimicrobial show that: Klebsiella pneumoniae drug sensitive rate was52.55%, and the resistant rate was41.63%. In3years, the resistant rate was43.79%,39.59%and42.09%respectively. The resistant rate was between69.23%and75%to penicillins,cephalosporins, tetracyclines, and large ring lactone class.The drug sensitive rate of Pseudomonas aeruginosa was52.29%, and the resistant rate was39.46%. The drug resistant rates were45.76%,38.70%and33.96%respectively every year. The resistant rates of Nitrofurans and Sulfa were99.22%and91.37%. The drug sensitive rate of Acinetobacter baumannii was24.83%and the resistant rate was68.41%. The drug resistant rates were74.42%,65.05%and61.21%respectively every year. The drug resistant rate was between61.82%and100%to Penicillins,Cephalosporins, β-lactams, Penicillium carbon alkenes,Tetracyclines, Nitrofurans and Sulfonamides. The drug sensitive rate of E. coli was48.64%and the resistant rate was46.76%. In3years,the resistant rates were40.49%,44.89%and58.34%, respectively. The drug resistant rates were between60.79%and75.00%to Penicillins,Cephalosporins, Large ring lactone class and Sulfas.4.2The drug resistant rate of the main gram-positive bacteriaIn2011-2013, the drugs susceptibility testing results of the mainly gram-positivebacteria to commonly used14kinds of55kinds of antimicrobial show that: The drug sensitive rate of the Epidermis staphylococcus was60.73%, and the drug resistant rate was36.58%. In3years, the resistant rate was38.7%、32.07%and34.52%respectively. The resistant rate was between82.4%and94.06%to Penicillins,Cephalosporins, Penicillium carbon alkenes and Large ring lactone class.The drug sensitive rate of the People staphylococcus was58.12%, and the drug resistant rate was40.31%. In3years, the resistant rate was43.98%,34.55%and33.87%respectively. The resistant rate was between70.93%and98.83%to Penicillins,Cephalosporins, Penicillium carbon alkenes, Large ring lactone class, Sugar peptides and Sulfonamides.The drug sensitive rate of the D excrement enterococcus was46.69%, and the drug resistant rate was41.46%. In3years, the resistant rate was37.37%、43.51%and48.14%respectively. The resistant rate was between80.00%and100%to Penicillins,Cephalosporins, Penicillium carbon alkenes, Large ring lactone class and Lincosamide antibiotics.The drug sensitive rate of the Staphylococcus aureus was69.58%, and the drug resistant rate was29.12%. In3years, the resistant rate was26.60%、28.76%and37.38%respectively. The resistant rate was between60.00%and75.00%to Penicillins,Cephalosporins, Beta lactams, Large ring lactone class andLincosamide antibiotics, and its drug sensitive rate was between60%and100%to the rest of the all kinds of antibacterial drugs.4.3The drug resistant rate of the fungalWhite candida was mainly fungi in fungal infection.Its drug sensitive rate was89.28%and the resistant rate was2.41%. In3years,the drug sensitive rates was95.11%,70.31%and96.21%, and the resistant rates were2.72%,3.93%and0.95%respectively.Conclusions1. The nosocomial infection rate was5.20%and the case-time hospital infection rate was6.55%in hospitalized children in Bayi children’s hospital. It was more susceptibility to hospitalized children than adults for the nosocomial infection.They were high-risk groups of the hospital infection (P<0.01).2. The nosocomial infection rates were2.93%,5.02%,8.57%,7.25%respectively in the NICU,PICU, children’s surgical wards and other pediatric ward. Compared with infection rate of different ward, the difference was statistically significant (P<0.01).The nosocomial infection rates of the hospitalized children in different departments exist differences (P<0.01). There were the risk characteristics of their respective for children in different wards. The infection rates were the highest (8.62%) in pediatric surgical ward,so pediatric surgery was one of the important part of hospital infection control. The nosocomial infection rates of the hospitalized children in NICU were the lowest. It was closely related to strengthen comprehensive monitoring and management, the environment and facilities relatively complete and ward management perfect. Strengthening the comprehensive monitoring and management of hospital infection can reduce the infection rate. Because of newborns were susceptibility for the hospital infection and complex factors such as illness, they who had a higher risk of infection were still the focus of protection and monitoring for the hospital infection.3. The lower respiratory tract ranked the first place, accounted for28.42%.then the hematological system, accounted for20.95%and the upper respiratory tract, accounted for14.45%.The main infection sites with the hospitalized children in the different ward were not the same.Their percentage changed.4. The hospital infection of the hospitalized children had difference in the different time (P<0.01). The change of hospital infection rate was not obvious among different years. That the hospital infection occurred were not significant relationship in different years (P>0.05). The infection rate were between4.79%and5.72%, of which the second quarter was the highest (5.72%) and the fourth quarter was the lowest (4.79%). It was a multiple trend in the second quarter. This may be related to climate characteristics of the regional and treated with different condition of children and so on.5. There were age distribution difference in the hospital infection with Hospitalized children (P<0.01).Infants and young children under the age of3years old were susceptible, high-risk groups (P<0.01), and were a key monitoring objects. In the age distribution, the hospital infection rate of children under3years old was5.42%, more than28d to1year old children hospital infection rates were9.92%.To strengthen the effective prevention and control of infection, can reduce the occurrence of hospital infection.6. Hospital infection were not linked to children with different gender. Among the44817cases of hospitalized children,the male accounted for61.93%and the female accounted for38.07%. The hospital infection rates of were5.32%and5.00%respectively.There was no statistically significant difference in infection rates for male and female (P>0.05) 7. Hospitalization days were positively correlated with the hospital infection.With the increase of hospitalization days, children infection rate was on the rise.the longer the length of hospital stay, the more prone to hospital infection (P<0.01).8.Hospital infection was closely related to the invasive operation (P<0.01)and invasive operation can increase the occurrence of hospital infection. In the group of patients, the hospital infection rate of them who had invasive procedures was8.47%.and had non-invasive procedures was4.16%.The incidence of nosocomial infection of children with surgery was18.89%.9.Hospital infection was closely related to the use of antimicrobial agents.the irrational use of antimicrobial drugs created conditions for conditional pathogenic bacteria infection, so increased the rate of infection with drug-resistant bacteria.lO.The gram-negative bacteria were given priority in the nosocomial infection pathogens.They were widespread resistance to Penicillin, Cephalosporin and Large ring lactone class.The pathogenic bacteria showed different drug resistance to commonly used antimicrobial agents.(1) In mainly gram-negative bacteria, Klebsiella pneumoniae, Acinetobacter baumannii and E. coli showed high resistance to Penicillin, Cephalosporin, Large ring lactone class or Tetracycline drugs.The drug resistant rates of Pseudomonas aeruginosa were as high as99.22%and91.37%. In3years, the resistant rate of Pseudomonas aeruginosa and Acinetobacter baumannii declined year by year. There was an upward trend in E. coli. The resistant rate of Klebsiella pneumoniae remained at39.59%to39.59%, which showed a trend of stability.(2) There were widespread resistance to Penicillin, Cephalosporin, Penicillium carbon alkene and Large ring lactone class for main gram-positive bacteria and they showed higher resistance. The resistant rate of Cuticle aureus and People staphylococcus declined at the lower level in3years. There were an upward trend in the resistant rate of D excrement enterococcus and Staphylococcus aureus year by year.(3) White candida was mainly fungi in fungal infection.Its drug sensitive rate was89.28%and the resistant rate was2.41%. In3years, the resistant rates were2.72%,3.93%and0.95%respectively.Dynamic monitoring the epidemiological characteristics with pathogenic bacteria of hospital infection in the hospital, strengthening the risk assessment and risk control for the hospitalized children with hospital infection, shortening the length of hospital stay, reducing children invasive operations, using reasonably antimicrobial agents according to the drug susceptibility results, implementing the targeted monitoring on the basis of a comprehensive monitoring and establishing a system and scientific management system, which are of great significance to prevent and control hospital infection for the hospitalized children...