Situation And Variation Tendency Of Multidrug-resistant Organism Infection In A General Hospital

Objective: From the data of cases monitoring on multidrug-resistant organism(MDRO),we aimed to find the patients of MDRO infection or colonization,analyze the situation of MDRO infection and variation tendency,and explore the reasons for the variation in order to determine the key population of MDRO prevention and to control the creating and spreading of MDRO.Methods: From 2013 to 2016,the MDRO were found by hospital infection professionals and laboratory staff from hospital laboratory information system(LIS)everyday,and duplicate specimens of the same patient were excluded.MDRO monitored included multidrug resistant/pan drug resistant acinetobacter baumannii(MDR/PDR-AB),methicillin-resistant staphylococcus aureus(MRSA),multidrug resistant/pan drug resistant pseudomonas aeruginosa(MDR/PDA-PA),vancomycin-resistant enterococci(VRE),carbapenems-resistant enterobacteriaceae(CRE).In 2013,when the patients were found to have MDRO,the hospital staff only notified the appropriate clinical departments by phone and monitor cases,i.e.the patients were registered and tracked one by one.Departments staff consciously completed the appropriate isolation measures.From 2014 to 2016,in addition to monitoring MDRO disease,a series of intervention measures were conducted,which including the implementation of disinfection and isolation,paying attention to hand hygiene,increasing the intensity of MDRO knowledge training,strengthening the management of key links,and the rational use of antimicrobial drugs.A process of Plan-Do-Check-Action was conducted every year.The descriptive epidemiological research methods were used to analyze the status and trends of MDRO infection from2013 to 2016.Results:1.From 2013 to 2016,a total of 546 cases of MDRO hospital infection were monitored.The nosocomial infection rate of MDRO was 0.24‰,and decreased year by year,which were 0.32‰,0.24‰,0.21‰,0.18‰ in 2013,2014,2015 and 2016,respectively(2trendc =25.829,P<0.001).From 2013 to 2016,there were 1273 caseswith MDRO in this hospital,total detective rate of MDRO was 4.30%,and decreased year by year,which were 4.84%,4.21%,4.12% and 3.99% in 2013,2014,2015 and2016,respectively(2trendc =6.554,P<0.05).The detective rate of MRSA and MDR/PDR-PA decreased year by year(2trendc =51.719,21.154,respectively,both P<0.001),while that of CRE increased year by year2trendc =59.346,P<0.001).The difference of detective rate of VRE and MDR/PDR-AB was not statistically significant(c 2=1.768,1.842,respectively,both P>0.05).2.From 2013 to 2016,the nosocomial infection rate of MDRO in ICU,cadre department and burn department has decreased year by year(c 2=27.270,9.503,10.338,respectively,all P<0.01).The difference of nosocomial infection rates of MDRO among department of neurosurgery,department of transplantation,ear-nose-throat department,orthopedics,hematology,nephrology,thoracic surgery and other departments were not statistically significant(P>0.05).During the four years,ICUwas ranked No.1 department of MDRO infection and MDRO hospital infections,followed by department of transplantation,neurosurgery etc.The proportion of MDRO hospital infection among MDRO detection in the Department of Transplantation and Neurosurgery was higher than those in the Department of Obstetrics and Gynecology,Infectious Diseases,Respiratory Medicine,and Integrated Traditional Chinese and Western Medicine.3.There were significant differences in the nosocomial infection rate and the detective rate of MDRO among different seasons(c 2=38.945,12.442,respectively,both P<0.01).The first season was the highest(0.36‰ and 4.46%,respectively),the fourth season was the lowest(0.19‰ and 3.44%,respectively).The proportion of MDRO hospital infection among MDRO detection in the first season was the highest,while that in the fourth season was the lowest.4.During the four years,the pathogens of MDRO cases and nosocomial infection cases were mainly MDR/PDR-AB(35.27% and 40.84%,respectively)andMRSA(40.14% and 28.57%,respectively).The number and percent of MSRA and MDR/PDR-PA decreased,while the number and percent of CRE increased.CRE had the highest proportion of hospital infection among MDRO detection(69.23%),while MRSA had the lowest proportion(30.53%).5.Most system of MDRO infection was respiratory system(71.25%),followed by the digestive system(12.45%),blood system,urinary system etc.Main systems of MRSA infection were respiratory system,skin and soft tissue system etc.Main systems of MDR/PDR-AB,MDR/PDR-PA,CRE infections were respiratory system,digestive system.Main systems of VRE infection were digestive system,urinary system etc.During the four years,the most source of MDRO specimen was respiratory tract secretions,followed by skin secretions,urine,etc.6.From 2013 to 2016,the consumption of hand washing were 4.90,7.64,10.86,11.43ml/bed-day,respectively.The amount of quick drying hand disinfectant were1.77,3.97,7.39,9.41ml/bed-day,respectively.The consumption of paper towels were 2.36,5.42,9.31,10.54 tissue/bed-day,respectively,increasing year by year.There was a negative correlation between the consumption of hand washing liquid,quick drying hand disinfectant,paper towels and the nosocomial infection rate of MDRO(r=-0.971?-0.953?-0.969,respectively,all P<0.05).Conclusions: From 2013 to 2016,the nosocomial infection rate and the detective rate of MDRO decreased year by year,which may be related to the increased consumption of hand washing liquid,fast dry hand disinfectant and paper towels year by year due to a series of intervention measures including the implementation of disinfection and isolation,paying attention to hand hygiene etc.The prevention and control targeted MDRO should be focused on the departments,time and key population with high infection rate.