Analysis Of Pathogenic Difference Of Nosocomial Infection Between Emergency Intensive Care Unit And General Ward

Objective To investigate the pathogen distribution and drug resistance of Nosocomial infection between emergency intensive care unit(EICU) and emergency general wards of Tianjin Medieal University between Jan 2013 and Jun 2014, Providing the basis of antibiotics usage for clinical.Method By retrospective survey method, we choosed patients who were hospitalized in emergency wards of Tianjin Medical University between Jan 2013 to June 2014.The step to diagnose nosocomial infection by according to clinical data, etiology findings, imaging data and a variety of professional diagnose. Collected data were statistically analyzed.To describe the distribution of pathogens in 18 months and the commonly used antibiotics susceptibility results of clinical common pathogens, then contrast the constituent ratio of samples between EICU and general ward, the distribution of multiple drug-resistant bacteria, the constituent ratio of gram-positive bacteria and gram-negative bacteria, to explore the change of bacterial resistance. Using SPSS17.0 statistical software processed the data, using test or Fisher’s exact test processed categorical data, P <0.05 was considered statistically significant.Results 1 A total of 96 patients developed Nosocomial infection(NI) in 402 patients came from EICU with the rate of infections was 23.89%,A total of 102 patients developed NI in 1925 patients came from the emergency general wards with the rate of infections was 5.30%.The incidence of NI in EICU compared with emergency general wards had statistically significant difference( 2=147.500,p<0.05). 2 A total of 259 strains in EICU and 193 strains in general ward were separated, the proportion of Gram negative bacteria, Gram positive bacteria and fungi was 73.36%, 15.06% and 11.58% in EICU respectively. In general ward, the proportion of Gram negative bacteria and Gram positive bacteria and fungi was 65.28%, 21.76% and 12.95% respectively. The constituent ratio of pathogens in EICU compared with emergency general ward had no statistically significant difference(P>0.05). 3 114 strains multiple drug-resistant bacteria were separated from 259 strains in EICU, accounting for 44.02%,including 33 strains of acinetobacter baumannii, 3 strains of pseudomonas aeruginosa, 21 strains of pneumonia klebsiella bacteria, 14 strains of Escherichia coli,14 strains of feces enterococci, 14 strains of Staphylococcus aureus. 74 strains MDR bacteria were separated from 193 strains in general wards, accounting for 38.34%, including 19 strains of pneumonia klebsiella bacteria, 9 strains of acinetobacter baumannii, 2 strains of pseudomonas aeruginosa, 12 strains of Escherichia coli, 14 strains of feces enterococci, 6 strains of Staphylococcus aureus. 20 strains of excrement enterococcus, 12 strains of E. coli. There were 28 β-lactamases producing strains in EICU, comparison of detecting rates was 14.74%. 17 strains of pneumonia klebsiella bacteria, 11 strains of Escherichia coli. The rate is 50%, 68.75%. In emergency general ward there were 23 β-lactamases producing strains, comparison of detecting rates was 18.25%. 14 strains of pneumonia klebsiella bacteria, 9 strains of Escherichia coli. The rate is 45.16%, 56.25%. We did not find vancomycin resistant gram-positive bacteria. There were 11 strains of acinetobacter baumannii which belonged to extensively drug resistant in EICU, and 3 strains in emergency general ward. The detection rate had no statistically significant difference(P>0.05) between EICU and emergency general ward. 5 Drug sensitivity result showed, in general ward the excrement enterococcus only had a higher sensitivity rate of vancomycin, Linezolid, and was resistant to most antibiotics. In EICU the staphylococcus aureus which had a higher infection rate only had a higher sensitivity rate of vancomycin, Linezolid, Compound Sulfamethoxazole aseparation, and others antibacterial drug sensitive rate are low, less than 40%. klebsiella pneumoniae and acinetobacter baumannii had a higher infection rates, no matter in EICU or general ward. Klebsiella pneumoniae had a higher sensitivity rate of Imipenem, amikacin, Peraeillin/Tazobaetam more than 90%, Acinetobacter baumannii had a higher sensitivity rate of Polymyxin B Sulfate, Tigecycline, Cefoperazone/sulbaetum, amikacin, the rate was more than 70%. Pseudomonas aeruginosa had a higher sensitivity rate of Meropenem, Imipenem, amikacin, ciprofloxacin, Ceftazidime more than 80%. In 55 strains fungi, Candida albicans had a higher sensitivity rate of fluconazole, Itraconazole, 5-Flucytosine Amphotericin B more than 90%. Candidatropicalis had a higher resistance rate of fluconazole, Itraconazole more than 50% in EICU. Candidatropicalis had a sensitivity rate more than 60%.Conclusions 1 The rate of nosocomial infection in EICU is significantly higher than the general ward. 2 The gram-negative bacteria are the predominant pathogens causing NI both in the EICU and the emergency general ward. Acinetobacter baumannii and klebsiella pneumoniae were the mainly gram-negative bacteria in EICU and general ward. Staphylococcus aureus and Enterococcus Faecium were the mainly gram-positive bacteria. 3. Gram-positive bacteria had a lower sensitivity rate to penicillin, Macrolides, fluoroquinolone, aminoglycoside, and had a higher sensitivity rate to vancomycin, Teicoplanin, tigecycline, linezolid. The sensitivity rate for Gram- negative bacteria in EICU was lower than the emergency general ward. Acinetobacter baumannii had a higher sensitivity rate to tigecycline, amikacin, Cefoperazone/Sulbactam, polymyxin B. klebsiella pneumoniae had a higher sensitivity rate to carbopenems, amikacin, piperacillin. E. coli had a higher sensitivity rate to carbopenems, amikacin, Cefoperazone/Sulbactam. Pseudomonas aeruginosa had a higher sensitivity rate to to Shubatan cefoperazone, meropenem, amikacin.