Changes of multidrug-resistant organisms in a tertiary general hospital around overall relocation_West China Medical Journal

Authors：

ZHANG Ju ¹ , LI Xiaojing ¹ , CHEN Min ² , LI Gang ³ , LUO Min ⁴ , CHEN Jie ⁵ , ZENG Xia ⁶ , YANG Junhua ¹ , ZENG Fengmei ¹ ,  MA Li ⁷ , LEI Hong ⁸ , PENG Limeng ⁹

1. Department of Nosocomial Infection Management, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
2. Department of Ophthalmology, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
3. Department of Traditional Chinese Medicine, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
4. Department of Clinical Laboratory, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
5. Department of Surgical Anesthesia Center, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
6. Department of Gastroenterology, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
7. Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
8. Department of Health Checkup Center, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
9. Ping’an Community Health Center of Longquanyi District, Chengdu, Sichuan 610100, P. R. China;

Corresponding?author：

MA Li, Email: 1004500237@qq.com

Keywords：

Tertiary general hospital; overall relocation; multidrug-resistant organism; change

DOI：

10.7507/1002-0179.202112111

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Objective To investigate the changes of multidrug-resistant organisms (MDROs) in the First People’s Hospital of Longquanyi District of Chengdu around its overall relocation. Methods The First People’s Hospital of Longquanyi District of Chengdu was overall relocated on December 31st, 2016. The detection rates of MDROs and the changes in nosocomial infections before the relocation (from 2015 to 2016) and after the relocation (from 2017 to 2020) were retrospectively analyzed. Results A total of 83634 qualified specimens were submitted for inspection, 8945 strains of pathogenic bacteria were detected, and the detection rate of pathogenic bacteria was 10.70%, showing an increasing trend in yearly detection rates of pathogenic bacteria (χ²_trend=8.722, P=0.003); among them, 1551 MDRO strains were detected, and the detection rate of MDROs was 17.34%, showing an increasing trend in yearly detection rates of MDROs (χ²_trend=11.140, P=0.001). The detection rate of pathogenic bacteria before relocation was lower than that after relocation, and the difference was statistically significant (9.64% vs. 11.08%; χ²=35.408, P<0.001); there was no significant difference in the detection rate of MDROs before and after relocation (16.32% vs. 17.66%; χ²=2.050, P=0.152). From 2015 to 2020, the detection rates of pathogenic bacteria from sputum+throat swab specimens (χ²_trend=81.764, P<0.001) and secretion+pus specimens (χ²_trend=56.311, P<0.001) showed increasing trends, while the detection rates of pathogenic bacteria from blood specimens (χ²_trend=110.400, P<0.001), urine specimens (χ²_trend=11.919, P=0.001), and sterile body fluid specimens (χ²_trend=20.158, P<0.001) showed decreasing trends. The MDRO detection rates of Escherichia coli (χ²_trend=21.742, P<0.001), Staphylococcus aureus (χ²_trend=47.049, P<0.001), and Pseudomonas aeruginosa (χ²_trend=66.625, P<0.001) showed increasing trends, while the MDRO detection rates of Klebsiella pneumoniae (χ²_trend=2.929, P=0.087) and Acinetobacter baumannii (χ²_trend=0.498, P=0.481) showed no statistically linear trend, but the MDRO detection rate of Acinetobacter baumannii dropped significantly in 2017. In the targeted monitored MDROs, the proportions of nosocomial infections in methicillin-resistant Staphylococcus aureus (χ²_trend=4.581, P=0.032), carbapenem-resistant Enterobacteriaceae (χ²_trend=8.031, P=0.005), and carbapenem-resistant Pseudomonas aeruginosa (χ²_trend=6.692, P=0.010) showed decreasing trends; there was no statistically linear trend in the proportion of nosocomial infections in carbapenem-resistant Acinetobacter baumannii (χ²_trend=0.597, P=0.440); only one strain of vancomycin-resistant Enterococcus was detected in 2017, and no nosocomial infection occurred. Conclusions The overall detection rate of pathogenic bacteria and MDROs in this tertiary general hospital around relocation showed increasing trends year by year. The detection rate of pathogenic bacteria after relocation was higher than that before relocation, but the detection rate of MDROs after relocation did not differ from that before relocation. The proportion of nosocomial infections among the targeted monitored MDROs decreased.

Citation： ZHANG Ju, LI Xiaojing, CHEN Min, LI Gang, LUO Min, CHEN Jie, ZENG Xia, YANG Junhua, ZENG Fengmei, MA Li, LEI Hong, PENG Limeng. Changes of multidrug-resistant organisms in a tertiary general hospital around overall relocation. West China Medical Journal, 2022, 37(3): 369-374. doi: 10.7507/1002-0179.202112111 Copy

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17.	劉衛平, 焦月英, 海云婷, 等. 某醫院多重耐藥菌感染分布趨勢與耐藥性分析. 中國消毒學雜志, 2018, 35(12): 931-933, 936.
18.	張毅, 彭玲玲, 黃麗玲. 廣東某軍隊醫院 2019 年多重耐藥菌檢出現狀及耐藥性分析. 東南國防醫藥, 2021, 23(1): 45-49.
19.	林秀娟, 林紅燕, 鐘韻. 某三甲醫院 2014-2016 年多重耐藥菌感染趨勢變遷. 廣東醫學, 2018, 39(1): 107-110.
20.	National Center Emerging and Zoonotic Infectious Disease. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). (2015-12-17)[2021-12-01]. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
21.	World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017. http://apps.who.int/iris/bitstream/10665/259462/1/9789241550178-eng.pdf?ua=1.
22.	Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect, 2014, 20(Suppl 1): 1-55.
23.	World Health Organization. Infection prevention and control. [2022-03-03]. https://www.who.int/health-topics/infection-prevention-and-control#tab=tab_1.
24.	楊啟文, 吳安華, 胡必杰, 等. 臨床重要耐藥菌感染傳播防控策略專家共識. 中國感染控制雜志, 2021, 20(1): 1-14.
25.	馬娟, 嚴曉華, 趙海, 等. 2018 年陜西省人民醫院細菌耐藥性監測. 中國感染與化療雜志, 2020, 20(2): 195-201.
26.	全國細菌耐藥監測網. 2014-2019 年細菌耐藥性監測報告. 中國感染控制雜志, 2021, 20(1): 15-31.
27.	馬爽, 張蕓, 王世富, 等. 碳青霉烯類抗生素暴露對老年重癥肺炎多重耐藥菌檢出率及預后的影響. 中國感染控制雜志, 2017, 16(11): 1056-1059.
28.	全國細菌耐藥監測網. 2014-2019 年不同等級醫院細菌耐藥監測報告. 中國感染控制雜志, 2021, 20(2): 95-111.

1. 中華人民共和國衛生部. 衛生部辦公廳關于印發《多重耐藥菌醫院感染預防與控制技術指南(試行)》的通知. 中華人民共和國衛生部公報, 2011(2): 59-61.
2. 胡付品, 郭燕, 朱德妹, 等. 2016 年中國 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2017, 17(5): 481-491.
3. 朱敬蕊, 崔琢, 汪振林, 等. 某三甲醫院常見多重耐藥菌流行趨勢分析. 蚌埠醫學院學報, 2020, 45(1): 94-97.
4. 陳國建, 楊潔, 鄧艾, 等. 某綜合醫院常見多重耐藥菌感染危險因素 logistic 回歸分析. 華西醫學, 2020, 35(3): 290-295.
5. 余佳佳, 李虎, 陶曉勤, 等. 2019 年上海交通大學醫學院附屬新華醫院細菌耐藥性監測. 中國抗生素雜志, 2021, 46(5): 442-449.
6. 蔡虻, 劉聚源. 多重耐藥菌醫院感染防控策略與思考. 中國護理管理, 2018, 18(12): 1590-1594.
7. 葛潔明, 范亞霞, 張文秋, 等. 2014-2018 年某三甲醫院多重耐藥菌的分布及趨勢分析. 中國煤炭工業醫學雜志, 2020, 23(3): 307-312.
8. 葉應嫵, 王毓三, 申子瑜. 全國臨床檢驗操作規程. 3 版. 南京: 東南大學出版社, 2006: 736-753.
9. 葉丹, 楊永紅, 張婷, 等. 某醫院下呼吸道感染分離菌分布及耐藥性監測. 中國實驗診斷學, 2020, 24(3): 386-389.
10. Clinical and Laboratory Standard Institute. M100-S23 Performance standards for antimicrobial susceptibility testing: twenty-third informational supplement: CLSI document M100-S23. Wayne, PA: Clinical and Laboratory Standard Institute, 2013.
11. 李春輝, 吳安華. MDR、XDR、PDR 多重耐藥菌暫行標準定義—國際專家建議. 中國感染控制雜志, 2014, 13(1): 62-64.
12. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
13. 中華人民共和國國家衛生和計劃生育委員會. 國家衛生計生委辦公廳關于印發麻醉等 6 個專業質控指標（2015 年版）的通知: 國衛辦醫函〔2015﹞252 號. (2015-03-31)[2022-02-01]. http://www.nhc.gov.cn/yzygj/s7657/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
14. 李六億, 吳安華. 胡必杰. 如何提高醫院感染預防與控制能力. 北京: 北京大學醫學出版社, 2015: 190-215.
15. 國家衛生健康委. 國家衛生健康委關于印發三級醫院評審標準（2020 年版）的通知: 國衛醫發〔2020﹞26 號. (2020-12-21)[2022-02-01]. http://www.nhc.gov.cn/yzygj/s7657/202012/c46f97f475da4d60be21641559417aaf.shtml.
16. 國家衛生健康委醫院管理研究所. 關于印發“提高住院患者抗菌藥物治療前病原學送檢率”專項行動指導意見的函: 國衛醫研函〔2021﹞198 號. (2021-10-28)[2022-02-01]. https://www.qiluhospital.com/uploadfile/2022/0120/20220120105510227.pdf.
17. 劉衛平, 焦月英, 海云婷, 等. 某醫院多重耐藥菌感染分布趨勢與耐藥性分析. 中國消毒學雜志, 2018, 35(12): 931-933, 936.
18. 張毅, 彭玲玲, 黃麗玲. 廣東某軍隊醫院 2019 年多重耐藥菌檢出現狀及耐藥性分析. 東南國防醫藥, 2021, 23(1): 45-49.
19. 林秀娟, 林紅燕, 鐘韻. 某三甲醫院 2014-2016 年多重耐藥菌感染趨勢變遷. 廣東醫學, 2018, 39(1): 107-110.
20. National Center Emerging and Zoonotic Infectious Disease. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). (2015-12-17)[2021-12-01]. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
21. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017. http://apps.who.int/iris/bitstream/10665/259462/1/9789241550178-eng.pdf?ua=1.
22. Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect, 2014, 20(Suppl 1): 1-55.
23. World Health Organization. Infection prevention and control. [2022-03-03]. https://www.who.int/health-topics/infection-prevention-and-control#tab=tab_1.
24. 楊啟文, 吳安華, 胡必杰, 等. 臨床重要耐藥菌感染傳播防控策略專家共識. 中國感染控制雜志, 2021, 20(1): 1-14.
25. 馬娟, 嚴曉華, 趙海, 等. 2018 年陜西省人民醫院細菌耐藥性監測. 中國感染與化療雜志, 2020, 20(2): 195-201.
26. 全國細菌耐藥監測網. 2014-2019 年細菌耐藥性監測報告. 中國感染控制雜志, 2021, 20(1): 15-31.
27. 馬爽, 張蕓, 王世富, 等. 碳青霉烯類抗生素暴露對老年重癥肺炎多重耐藥菌檢出率及預后的影響. 中國感染控制雜志, 2017, 16(11): 1056-1059.
28. 全國細菌耐藥監測網. 2014-2019 年不同等級醫院細菌耐藥監測報告. 中國感染控制雜志, 2021, 20(2): 95-111.

West China Medical Journal

Changes of multidrug-resistant organisms in a tertiary general hospital around overall relocation

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