目的 分析乳糜腹患者腹腔感染病原菌的分布及耐药性,为临床合理选择抗感染药物提供参考.方法 回顾性分析2016年1月至2021年5月北京世纪坛医院乳糜腹住院患者病例资料和送检腹腔积液的病原菌培养和药敏试验结果.结果 2016年1月至2021年5月腹腔积液培养阳性的乳糜腹患者共27例,分离菌株共37株.其中革兰阳性菌20株(54.05％),主要为肠球菌属和葡萄球菌属,检出3株MRCNS和1株MRSA,革兰阳性菌对万古霉素、利奈唑胺高度敏感.革兰阴性菌16株(43.24％),肠杆菌科9株,非发酵菌6株(37.5％),检出1株产ESBLs大肠埃希菌,革兰阴性菌对厄他培南、美罗培南、头孢哌酮钠舒巴坦钠敏感率高.真菌1株(2.7％),为白色假丝酵母菌.结论 乳糜腹患者腹腔感染病原菌种类较多,革兰阳性菌略高,革兰阳性菌主要以肠球菌属和葡萄球菌属为主,革兰阴性菌中以肠杆菌为主,临床应合理选择抗菌药物.

目的 整理分析北京世纪坛医院2015-2019年上报的水痘患者数据,了解水痘流行病学特征,为水痘疫情监测提供一定的参考依据.方法 通过中国疾病预防控制报告系统导出北京世纪坛医院2015-2019年水痘报告记录,采用Excel对数据进行整理,SPSS 22.0进行统计分析.结果 北京世纪坛医院2015-2019年累计上报水痘患者446例,男女比例为1.14∶1.发病年龄为3月～66岁,平均20岁,其中1～10岁组为一个发病高峰,＞20～35岁组为一个发病高峰.446例水痘患者中儿童患者262例,成人患者184例,2018-2019年成人水痘患者构成比与2015-2017年相比升高,儿童水痘患者构成比下降,差异有统计学意义(x2=10.435,P＜0.05).水痘全年均可发病,发病时间呈双高峰,分别在4-5月及10-11月.水痘患者主要来自北京市海淀区(44.3％)和其他县区(45.8％),职业主要为学生(29.2％)、干部职员(30.1％)和散居儿童(12.4％).结论 北京世纪坛医院2015-2019年水痘患者的发病年龄推迟,近两年成人患者构成比升高.水痘全年发病,季节呈双高峰,水痘疫情的防控需关注季节温度变化.

目的 探讨老年恶性肿瘤患者发生院内感染和多重耐药菌(multiple drug resistant organisms,MDRO)感染的危险因素,为制订有效的院内感染预防控制措施提供科学依据.方法 回顾性分析2015年1月-2019年12月我院收治的60岁以上恶性肿瘤患者的病历资料,应用多因素logistic回归分析老年恶性肿瘤患者发生院内感染和MDRO感染的危险因素.结果 老年恶性肿瘤患者院内感染发生率为25.27％,MDRO感染率为31.69％.logistic回归分析显示,中至重度衰弱、合并糖尿病、侵入性操作和长期卧床是老年恶性肿瘤患者发生院内感染[OR(95％CI):3.26(1.22～5.47)、1.77(1.20～2.53)、1.96(1.28～3.48)和2.14(1.67～3.89)]和发生 MDRO感染的危险因素[OR(95％CI):2.35(1.13～5.67)、1.84(1.15～4.62)、2.38(1.41～5.52)和 1.21(1.35～3.89)];合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、住院时间≥14d和低白蛋白水平仅是院内感染的危险因素[OR(95％CI):2.01(1.22～4.08)、2.23(1.41～4.33)和1.21(1.05～2.77)];ICU入住时间≥1周、应用抗菌药物≥3种和抗菌药物应用时间≥14 d仅是MDRO感染的危险因素[OR(95％CI):2.55(1.50～5.63)、1.91(1.23～4.15)和2.11(1.32～4.28)].结论 老年恶性肿瘤患者院内感染率和 MDRO感染率均较高,并且危险因素较多,应针对这些危险因素采取科学有效的预防控制措施,以降低院内感染和MDRO感染的发生率.

新冠肺炎严重威胁人类生命安全和身体健康,广大医务工作者为拯救患者生命不懈努力,而医院后勤系统为医院正常运行提供保障.面对重大疫情,首都医科大学附属北京世纪坛医院后勤系统采取网格化管理,围绕患者就诊、医护诊疗、后勤服务3条主线,健全服务评价系统,抓好重点环节管控,制定启动应急预案,有效降低医院感染风险.通过抓住后勤保障工作中疫情防控重点,创新管理举措,统筹协调、责任到人,完善了“人流、物流、信息流”的全要素管理,为提高疫情防控工作处置效率奠定了坚实基础,取得了良好成效.

目的 分析食管癌根治术后患者院内感染病原菌分布特点及耐药性情况,为临床诊治提供依据.方法 回顾性分析2014年4月 ～2019年4月180例发生院内感染的食管癌根治术后患者的一般临床资料,总结病原菌培养结果 及多重耐药性情况.结果 食管癌根治术后患者在院治疗期间发生的最常见的院内感染是下呼吸道感染(32.8％),其次是手术切口(21.1％)、胸腔(15.0％)和上呼吸道感染(13.3％).180个标本共分离出276株病原菌,其中革兰阴性菌164株(59.4％),以大肠埃希菌(11.6％)最多;革兰阳性菌78株(28.3％),主要为金黄色葡萄球菌(8.3％);真菌34株(12.3％),以白色念珠菌为主(5.1％).药敏试验显示几种主要革兰阴性菌对头孢唑林、氨苄西林、阿莫西林-克拉维酸及复方新诺明具有较高耐药性,对头孢哌酮-舒巴坦、亚胺培南和美罗培南较为敏感;几种主要革兰阳性菌对青霉素、红霉素、阿奇霉素和头孢唑林具有较高耐药性,对万古霉素和利奈唑胺较敏感;几种主要真菌对氟康唑、两性霉素B具有较高耐药性,对酮康唑、咪康唑较为敏感.结论 食管癌根治术后患者最易发生院内感染的部位是下呼吸道,最常见的病原菌类型是革兰阴性菌,且耐药严重,存在多重耐药菌,临床上应该做好相应的预防工作及合理选择抗菌药物.

目的 分析老年肺癌患者术后发生院内肺部感染的病原菌分布特点及耐药性情况,为临床诊治提供一定参考依据.方法 回顾性分析2016年8月—2019年8月收治的496例老年肺癌手术患者的临床资料,统计术后发生院内肺部感染的情况,总结肺部感染痰培养的细菌分离株及多重耐药性情况.结果 496例老年肺癌患者术后发生院内肺部感染者117例(23.6％);共分离出162株病原菌,以革兰阴性菌(103株,63.58％)为主,其次为革兰阳性菌(38株,23.46％)和真菌(21株,12.96％).药物敏感(药敏)试验结果显示革兰阴性菌、革兰阳性菌及真菌对常用抗菌药物的耐药率均较高.结论 老年肺癌患者术后院内肺部感染发生率较高,最常见的病原菌是革兰阴性菌,且细菌耐药严重,甚至出现较多的多重耐药菌,临床上要加强病原菌的培养和药敏试验,合理选择抗菌药物.

目的 探讨术后患者肺部感染发生的危险因素.方法 选取2012年1月至2016年12月首都医科大学附属北京世纪坛医院发生术后肺部感染的276例患者作为病例组,以同期未发生医院感染的68 279手术病例作为对照组,回顾性分析两组患者的基本情况、手术情况等因素,分析术后患者肺部感染的高危因素.结果 单因素分析显示,病例组与对照组比较,男性比例(59.4％ vs.33.8％,P＜0.001)、退(离)休人员比例(56.2％ vs.32.0％)、平均年龄[(65.99±16.83)岁vs.(49.58±19.39)岁]、手术医师职称、切口清洁度、麻醉方式、术前住院日[9(2,420)d vs.5(2,425)d]的差异均有统计学意义(P＜ 0.001).Logistic回归分析显示,高龄(OR=1.96)、男性(OR=1.95)、Ⅱ类及以下切口清洁度(OR=0.59)、术前住院日(OR=1.92)、全身麻醉(OR=8.94)为患者术后肺部感染的影响因素(P＜ 0.001).结论 高龄、男性、术前住院日长等因素与术后肺部感染发生有关,全身麻醉术后肺部感染发生的风险最高.选择合适的麻醉方式,加强男性、高龄患者术后护理,可减少术后患者肺部感染的发生.

目的 了解某医院重点科室多重耐药菌(MDRO)的分布及耐药性,为临床抗菌药的使用提供科学依据.方法 收集2016—2017年首都医科大学附属北京世纪坛医院重点科室收治患者的痰液、尿液等各类标本,按照《全国临床检验操作规程》进行标本的接种分离与鉴定,并进行药物敏感性实验.结果 共分离出病原菌2080株.其中,泛耐药鲍曼不动杆菌(PDR-ABA)最多,为969株,占46.59％;其次为泛耐药铜绿假单胞菌(PDR-PAE)、大肠埃希菌(ECO)和耐甲氧西林金葡菌(MRSA).病原菌主要分布在重症监护室(ICU)、呼吸内科和急诊科病区,其中,ICU占52.45％,呼吸内科和急诊科病区分别占11.92％、9.95％.检出的病原菌分布以G-菌为主,共1652株,占79.42％,G+菌428株,占20.58％.G-菌对青霉素G、红霉素、克林霉素和万古霉素敏感性较高,余均有不同程度的耐药;G+菌对头孢类、哌拉西林、厄他培南、亚胺培南药物素敏感性较高,余均有不同程度的耐药,检出耐万古霉素肠球菌(VRE).结论 MDRO主要为条件致病菌,其中,以G-菌较为多见,且无论是G+菌还是G-菌对常用抗生素均广泛存在不同程度的耐药.

目的 探讨外周血肺炎支原体抗体(mycoplasma pneumoniae Immunoglobulin M,MP-IgM)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、肺表面活性蛋白A(pulmonary surfactant protein A,SPA)及白细胞介素-10(interleukin 10,IL-10)表达在院内获得性肺炎患者治疗及预后中的评价意义.方法 选取2016年1月至2017年12月本院确诊的100例院内获得性肺炎患者为观察组给予对症治疗,选取同期健康体检患者50例为对照组.分别检测患者外周静脉血中MP-IgM、TNF-α、SPA及IL-10表达水平.结果 与对照组相比,观察组患者血清内TNF-α、SPA及IL-10表达水平显著升高,血清MP-IgM呈明显阳性,随着疾病程度的加重,表现更为明显(P＜0.05);观察组血清内TNF-α、SPA及IL-10表达水平治疗后显著降低,血清MP-IgM阳性减少(P＜0.05).院内获得性肺炎患者体内TNF-α、SPA及IL-10含量,MP-IgM阳性率与疾病严重程度存在显著的正性相关关系,P ＜0.05.经ROC分析可知,MP-IgM、TNF-α、SPA及IL-10这4项生物学标志物并联试验灵敏度为92.00％,串联试验特异性为100.00％,显著大于各单项生物学标志物检测(P＜0.05).结论 外周静脉血中MP-IgM、TNF-α、SPA及IL-10表达在院内获得性肺炎患者体内异常升高,给予药物治疗后患者病情缓解,外周静脉血中MP-IgM、TNF-α、SPA及IL-10变化有利于监测在院内获得性肺炎患者的病情程度和治疗,值得推广研究.

目的 了解我院铜绿假单胞菌获得性肺炎患者病原菌的分布及耐药情况.方法 选取2016年7月至2017年12月我院送检的获得性肺炎患者痰液培养标本,采用VITEK2-COMPACT全自动微生物分析仪进行菌株鉴定和药敏分析.结果 总共检出358株铜绿假单胞菌,主要分布于呼吸内科和ICU.患者主要基础疾病为慢性阻塞性肺疾病、慢性支气管炎、脑梗死、脑出血等.检出的铜绿假单胞菌对复方新诺明耐药率最高,对阿米卡星耐药率最低.铜绿假单胞菌耐药率由低到高依次为妥布霉素、哌拉西林/他唑巴坦、庆大霉素、头孢他啶、头孢哌酮/舒巴坦、头孢唑肟钠、头孢曲松钠、亚胺培南和左氧氟沙星.结论 我院需要加强对碳青霉烯类和含β-内酰胺酶抑制剂药物的管控,减少这些药物的使用强度,各临床科室尤其是呼吸内科和ICU需及时监控铜绿假单胞菌的耐药情况,合理使用抗生素,从而逐步降低病原菌耐药状况.

目的 探讨实施规范化护理流程对脑胶质瘤患者预防医院感染的临床效果.方法 选取2016年1月-2017年12月收治的2262例接受放疗、化疗的脑胶质瘤患者为研究对象,其中2016年1-12月1092例患者为对照组,实施常规护理;2017年1-12月1170例患者为试验组,在常规护理基础上,实施规范化护理流程,采用统计软件对两组患者医院感染发生率和骨髓抑制程度情况进行分析.结果 试验组医院感染率为09.4％,低于对照组的医院感染率21.1％,差异有统计学意义(χ2=51.80,P=00.23);两组患者均出现不同程度的骨髓抑制,对照组患者骨髓抑制程度重于试验组,差异有统计学意义(Z=-24.29,P=00.15).结论 对脑胶质瘤患者实施规范化护理流程,可以降低患者的医院感染率,减轻患者的骨髓抑制程度.

Mortality associated with infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) is high and the infections need to be predicted early. The risk factors for CR-KP infection are heterogeneous. The aim of the present study was to construct a model allowing for the early prediction of CR-KP infection. Nosocomial infections due to K. pneumoniae were evaluated retrospectively over a 2-year period. The case cohort consisted of 370 inpatients with CR-KP infection. For each case enrolled, two matched controls with no CR-KP infection during their hospitalization were randomly selected. Matching involved month of admission, ward, as well as interval days. The Vitek 2 system was used for identification of isolates and antimicrobial susceptibility testing. General linear model with logistic regression was used to identify possible risk factors. The predicted power of the model was expressed as the area under the receiver-operating characteristic curve. Age, male gender, with cardiovascular disease, hospital stay, recent admission to intensive care unit, indwelling urinary catheter, mechanical ventilation, recent β-lactam-β-lactamase inhibitors, fourth-generation cephalosporins and/or carbapenems therapy were independent risk factors for CR-KP infection. Models predicting CR-KP infection developed by cumulative risk factors exhibited good power, with areas under the receiver-operating characteristic curves of 0.902 [95% confidence interval (CI), 0.883-0.920; P<0.001] and 0.899 (95% CI, 0.877-0.921; P<0.001) after filtering by age (≥70 years). The Yonden index was at the maximum when the cumulative risk factors were ≥3 in the two prediction models. The results show that the prediction model developed in the present study might be useful for controlling infections caused by CR-KP strains.

目的 评价手术患者清洁切口围手术期预防使用抗菌药物管理效果,促进围手术期抗菌药物合理应用.方法 通过回顾性调查和手术患者切口感染率监测方法,对某医院住院清洁切口手术患者围手术期预防性使月抗菌药物情况进行目标监测.结果 通过综合干预措施,该医院实施清洁切口手术患者围手术期预防性抗菌药物使用率由干预前的66.36％下降到24.74％.预防用药天数由原来的近4.26 d,缩短到1.73 d以下.结论 通过对抗菌药物围手术期应用的综合干预,抗菌药物预防用药明显规范.

OBJECTIVE To standardize the prophylactic use of antibiotics during perioperative period of clean inci-sion surgery ,explore effective intervention measures ,and understand the intervention effect so as to promote the reasonable use of antibiotics during the perioperative period .METHODS The targeted monitoring was performed for all the patients who underwent the clean incision surgery in the hospital from Jul 2011 to Dec 2013 ,then the corresponding organizations were set up according to the requirements of rectification for antibiotics by the health administrative departments with the combination of the actual reality of the hospital ,and highly workable meas-ures were formulated to promote the implementation ,the management was intensified ,the intervention effect was evaluated ,the statistical analysis was performed with the use of SPSS10 .0 ,and the count data were analyzed by using the chi-square test .RESULTS Through the comprehensive intervention ,the utilization rate of antibiotics of the patients undergoing the clean incision surgery was significantly reduced ,decreasing from 90 .26% in Jul 2011 to 25 .12% in Dec 2013 ,the difference was significant (P<0 .01) .The administration rate at 30 min-2 hours be-fore the surgery was persistently elevated ,increasing from 81 .33% in Jul 2011 to 94 .29% in Dec 2013 ,the differ-ence was significant (P<0 .01);the administration rate at30 min-2 hours before the surgery was persistently ele-vated ,increasing from 81 .33% in Jul 2011 to 94 .29% in Dec 2013 ,the difference was significant (P<0 .01) .The proportion of the patients with the time of prophylactic use of antibiotics no more than 24 hours continued to rise , increasing from 6 .22% in Jul 2011 to 68 .57% in Dec 2013 ,the difference was significant(P<0 .01) .The duration&nbsp;of the prophylactic use of antibiotics was persistently shortened ,decreasing from 5 .2 days in Jul 2011 to 1 .49 days in Dec 2013 .For the choice of antibiotics ,the empirical or habitual use of cephamycins ,third generation cephalo-sporins or enzyme-containing inhibitors was administered previously ,and until now the standardized use of first or second generation cephalosporins could be performed .CONCLUSION The perioperative prophylactic use of antibi-otics has been significantly standardized through the comprehensive intervention .

OBJECTIVE To investigate and analyze of multidrug-resistant organism(MDRO) infections in hospitalized patients in a three-A general hospital in 2011 so as to provide reliable data for reducing the MDROs infections.METHODS The specimen source,clinical distribution,and constituent ratios of the MDROs isolated from clinical specimens between Jan and Dec 2011 were retrospectively analyzed.RESULTS A total of 2543 strains of MDROs in 6 species were isolated,accounting for 8.93% among all the isolated bacteria;73.41% of the MDROs were isolated from the sputum specimens,followed by the urine.The multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were dominant in the MDROs,accounting for 31.81% and 30.00%,respectively.48.72% of the MDROs infections distributed in ICU,34.13% in the respiratory medicine department.CONCLUSION The refractory infections caused by the MDROs are increased,which brings the use of antibiotics the great pressure and challenge.It is of great significance in reducing the outbreak and prevalence of the MDROs to strengthen the monitoring of MDROs.

Objective To investigate the hand hygiene situation of medical staff in order to carry out supervision of hand hygiene.Methods Retrospective investigation was used to monitor the hand hygiene disinfection effect and compliance of a hospital in Beijing.Results From Jan 2009 to Dec 2011,132 medical staff who worked at clinical lot were analyzed.The total qualified rate was 76.52%,the qualified rate of hand hygiene of doctors was 63.69%,and it was 80.65% for nurses.Pathogenic bacteria and antibiotic-resistant bacteria were not found.Hands washing compliance rate for nurses is 24.14%,8.33% for doctors,no statistical difference between them.Conclusion The hand hygiene qualify rate and the hand washing compliance rate are low.We should strengthen the management.

OBJECTIVE To know the status of the prophylactic use of antibiotics during the type Ⅰ surgery and strengthen the management of antibiotic application during the perioperative period.METHODS A total of 1395 cases of type Ⅰ surgery being taken from Jun to Oct 2011 were reviewed by professional personnel of hospital infections,then the forms were filled out one by one and were statistically analyzed,and the changing trend of qualified rate was examined by chi-square test.RESULTS The utilization rate of antibiotics was 75.77% during the type Ⅰ surgery,the qualified rate of the medication timing was 60.43%,the qualified rate of the duration of antibiotic prophylaxis for surgery was 17.71%.The most frequently used antibiotics were cefoxitin,cefotiam,and piperacillin/sulbactam.By the hospital's intensive management,the utilization rate of antibiotics during the perioperative period of type Ⅰ surgery was increasingly decreased,keeping a downward trend(χ2=111.32,P< 0.01);the qualified rate of the antibiotic application time showed an increasing trend(χ2=77.44,P<0.01).CONCLUSION The use of antibiotics during the perioperative period is unreasonable,and the medication is improved after the quality management,it is necessary to continue to strengthen the policy control.

<正>医疗质量是医院生存发展的根本,是评价医院整体水平的核心指标,是医院管理永恒的主题。随着医药卫生体制改革的逐渐深入,加强医院医疗质量管理体系建设,提高医疗服务水平,构建和谐医患关系的重要性愈显突出。近年来,首都医科大学附属北京世纪坛医院在医疗质量管理方面推行精细化管理,在强化医疗质量管理体系建设方面积累了一定经验,取得了显著成效。

OBJECTIVE To investigate the current status of targeted surveillance for invasive procedure-associated infections and the fulfillment of preventive measures in ICU of tertiary care hospitals in Beijing.METHODS The generic evaluation forms were designed,the investigators were trained,38 Beijing′s tertiary care hospitals′ ICU were evaluated on-site.RESULTS Of 38 tertiary care hospitals,36 hospitals carried out targeted surveillance for invasive operation-associated infections;all of the 36 hospitals had developed the surveillance for central venous catheter-related bloodstream infections(CRBSI) with the catheter infection rate of 2.5 per 1000 patient-days;26 hospitals had developed the surveillance for catheter-associated urinary tract infections(CAUTI) with the catheter infection rate of 2.1 per 1000 patient-days,88.5% of the hospitals no longer executed the routine bladder irrigation;28 hospitals had developed the surveillance for ventilator-associated pneumonia with the catheter infection rate of 7.6 per 1000 patient-days,71.5% of the hospitals carried out oral nursing twice a day for the catheterization patients,and 53.6% of the hospitals conducted oral nursing with chlorhexidine as collutory.CONCLUSION Most of the tertiary care hospitals have carried out the targeted surveillance.Preventive measures about invasive procedure-associated infections should be further standardized.

OBJECTIVE To investigate the epidemic situation,and antibiotics resistance of Acinetobacter baumannii and treatment of its infection.METHODS ABA isolated from clinic from 2007-2009 were retrospectively analyzed.The specimen source,infection in different departments and drug resistance were also analyzed.RESULTS The detection rate of ABA was increasing quickly.Most of them were isolated from sputum samples(95.24%).ABA showed high drug resistance and multi-drug resistance,the resistance rate to imipenem was 66.82%,with rising trend.IR-AB(imipenem-resistant ABA) infection was found mostly in ICU,accounting for 52.34%,followed by the respiratory ward 23.83%.the drug resistant rate to polymyxin was 0,followed by to cefoperazone/sulbactam with 1.45%,minocycline with 7.09%,and to amikacin with 50.17%.CONCLUSION ABA is the most common pathogen in respiratory tract infection,treatment to IR-AB faces the selection pressure.The joint application of cefoperazone/sulbactam,minocycline and amikacin may be the best choice for the treatment.