Present Situation Investigation And Drug Resistance Analysis Of Nosocomial Infection Pathogens In Intensive Care Unit

Objective:1To undestand the prevalence rate and infection distributions of nosocomial infection in ICU(Intensive Care Unit, ICU) of Cangzhou People’s Hospital.2To understand the present situation, pathogens epidemiologic features and drug resistance of nosocomial infection pathogens in ICU of our hospital.3To investigate the relationship between nosocomial infection and invasive operation.4To investigate the impacts of a series of infection prevention and control measures on nosocomial infection in ICU and drug resistance of multidrug resistant bacteria, to provide a basis for the prevention and control of nosocomial infection in ICU.Methods:1 Made a retrospective survey on 1269 hospitalized patients who were in ICU from 2013 January to 2014 December, and designed a registration form according to the survey content.2 By using a prospective method, starting from 2014 January, we have implemented the management target monitoring of nosocomial infection in ICU, established the daily records of nosocomial infection in ICU.3 To referred the ICU nosocomial infection management files, and according to filled in the "Registration Form" for patients with nosocomial infection,and to summarize the relevant data of 170 hospital nosocomial infection from 2013 to 2014 in ICU, collection and sorting of medical record such as sex, age, date of infection, hospitalization days, predisposing factors, invasive operation, pathogens and drug sensitivity.4 We established a database in Excel, and made a statistical analysis with SPSS17.0 software. The enumeration data were described in rate or constituent ratio, and the comparison of enumeration data was checked with chi-square(χ2). We concluded whether there was statistical significance or not by taking P <0.05 as the difference.Results:1 From 2013 to 2014, there were 170 patients with nosocomial infection, 254 infection cases, the nosocomial infection rate was 13.40%, and the rate of nosocomial infection cases was 20.02%.2 The common infection sites were lower respiratory tract(53.94%) and urinary tract(23.63%), blood(15.35%), abdominal cavity(2.36%), chest(2.36%), and incision(1.18%).3 There was a direct relationship among ventilator related pneumonia, urinary catheter related urinary tract infection, catheter related bloodstream infection and invasive operation of "three tubes"(P<0.05).4 From 2013 to 2014, there were a total of 419 strains of bacterial strain isolated in patient with nosocomial infection, mainly from sputum culture 248 strains, accounting for 59.19%, followed by urine culture 68 strains, accounting for 16.22%, blood culture 46 strains, accounting for 10.98%, catheter culture 39 strains, accounting for 9.31%, hydrothorax, ascites, incision and others 18 strains, accounting for 4.30%. There were a total of 419 strains of pathogens isolated from 170 patients with nosocomial infection, mainly gram negative bacilli, 267 strains, accounting for 63.72%;110 strains of gram positive bacteria, accounting for 26.25%, ranking second; and 42 strains of fungi, accounting for 10.03%. The top five nosocomial infection pathogens respectively were Bauman Acinetobacter 15.75%(66/419), Pseudomonas Aeruginosa14.08%(59/419), Escherichia Coli 11.93%(50/419), Staphylococcus Aureus 8.83%(37/419), and Klebsiella Pneumoniae 8.35%(35/419). Compared with 2013, in 2014, the the isolation rate of drug resistant bacteria of Pseudomonas Aeruginosa in multidrug resistant bacteria increased, the isolation rates of other multidrug resistant bacteria the isolation rates of which were all greater than 50% decreased, which had a statistical significance. The isolation rate of multidrug resistant Pseudomonas Aeruginosa rose, with multiple resistance to antibiotics, cefepime increased compared with before.Conclusions: ICU nosocomial infection rate is high, the main infection site is lower respiratory tract, and there is a close relationship among ventilator use days, urinary catheter reservation days, central venous catheter reservation days, application of antibiotics and multidrug resistant bacteria infection. The pathogens isolated from the ICU nosocomial infection are mainly gram negative bacilli, and most of them are multidrug resistant bacteria. The drug resistance of isolated nosocomial infection multidrug resistant bacteria to common antibiotics is different, and significant changes in drug resistance. Compared with 2013, in 2014, we have strengthened nosocomial infection prevention and control measures, however, the incidence of nosocomial infection was not improved, by considering and analyzing, we concluded it was related to multiple factors, including the severity of illness, average hospitalization days and so on.