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CLC number: R181.2+2

On-line Access: 2015-01-05

Received: 2014-04-18

Revision Accepted: 2014-10-28

Crosschecked: 2014-12-24

Cited: 3

Clicked: 4565

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Jian-nong WU

http://orcid.org/0000-0001-8867-9860

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Journal of Zhejiang University SCIENCE B 2015 Vol.16 No.1 P.70-77

http://doi.org/10.1631/jzus.B1400108


Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study


Author(s):  Jian-nong Wu, Tie-er Gan, Yue-xian Zhu, Jun-min Cao, Cong-hua Ji, Yi-hua Wu, Bin Lv

Affiliation(s):  Department of Hospital Infection Control, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China; more

Corresponding email(s):   lvbin@medmail.com.cn

Key Words:  Nosocomial bloodstream infection, Traditional Chinese medicine hospital, Epidemiology, Microbiology


Jian-nong Wu, Tie-er Gan, Yue-xian Zhu, Jun-min Cao, Cong-hua Ji, Yi-hua Wu, Bin Lv. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study[J]. Journal of Zhejiang University Science B, 2015, 16(1): 70-77.

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author="Jian-nong Wu, Tie-er Gan, Yue-xian Zhu, Jun-min Cao, Cong-hua Ji, Yi-hua Wu, Bin Lv",
journal="Journal of Zhejiang University Science B",
volume="16",
number="1",
pages="70-77",
year="2015",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1400108"
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%T Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study
%A Jian-nong Wu
%A Tie-er Gan
%A Yue-xian Zhu
%A Jun-min Cao
%A Cong-hua Ji
%A Yi-hua Wu
%A Bin Lv
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A1 - Tie-er Gan
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A1 - Cong-hua Ji
A1 - Yi-hua Wu
A1 - Bin Lv
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DOI - 10.1631/jzus.B1400108


Abstract: 
In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

医院获得性血流感染的流行病学和病原学特征分析:482例感染病例的回顾性调查

目的:分析某三级中医院医院获得性血流感染(nBSIs)的流行病学和病原学特征,探索影响28天病死率的相关危险因素。
创新点:纳入2009~2011年所有确诊的血流感染病例,而非只依靠血培养结果做判定。收集包括患者的基础性疾病、侵入性操作等感染相关危险因素、标本送检及抗菌药物使用情况等全面的临床资料,分析了nBSIs的发生率、病区分布、人群分布、病原体分布、细菌耐药性及病死率,并对影响死亡的危险因素进行了多因素分析。
方法:采用回顾性调查的方法,从病历资料中获得预先设置好的相关信息。病原体的分离鉴定和药敏检测由医院微生物实验室专职人员完成。使用WHONET5.6软件对药敏结果进行分析。采用SPSS16.0对所有数据进行统计分析,死亡危险因素判定先用单因素分析,再用多因素Logistic回归分析。
结论:某三级中医院nBSIs的发生率为5.7/1000入院人数,大肠埃希菌和凝固酶阴性的葡萄球菌(CoNS)是检出最多的两种细菌。约有1/3的肠杆菌对第三代头孢菌素耐药(表4),90.7%的CoNS对甲氧西林耐药(表3)。碳青霉烯类和糖肽类是用于治疗nBSIs使用最广泛的两类抗生素(图1)。感染性休克、血液透析、Pitt菌血症得分>4和尿路感染是28天死亡的危险因素,而合理的经验性用药可以明显改善预后(表6)

关键词:医院获得性血流感染;中医院;流行病学;病原学

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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