Objective To know the status quo of multidrug-resistant organism (MDRO) infection in primary general hospitals, analyze the differences among various intervention measures, and put forward guiding principles for MDRO infection control in primary general hospitals. Methods We investigated all patients (n=51 612) admitted into the hospital between January 2013 and December 2015, and found out 6 types of MDRO. Pre-interventional investigation was carried out between January 2013 and June 2014 (before intervention) during which no intervention measures were taken; Intervention was carried out between July 2014 and December 2015 (after intervention). All departments in the hospital (6 groups) were matched with intervention measures (6 groups) randomly. Then, we compared the MDRO detection rate, nosocomial infection case rate and intervention compliance rate among the groups. Results We detected altogether 611 MDRO cases (without duplication) out of the 51 612 cases. The total detection rate of MDRO was 1.18%. The detection rate of MDRO before and after intervention was 1.37% and 1.01%, respectively. The difference between the two was of statistical significance (P<0.05). After the intervention, the detection rate in groups 1, 5 and 6 was significantly lower than before (P<0.05); the differences in detection rate among groups 2, 3, and 4 were not significant (P> 0.05). Nosocomial infection rate decreased from 0.28% before intervention to 0.14% after intervention (P<0.05). After the intervention, MDRO nosocomial infection case rate of groups 1, 5 and 6 was significantly lower than before (P<0.05); the rate was lower in groups 3 and 4 than before without any significance (P>0.05); no MDRO cases were detected in group 2 and comparison was meaningless. The knowledge rates of medical workers and of nursing staff increased from 52.97% and 20.00% before intervention to 78.76% and 66.34% after intervention, respectively (χ2=30.670, 38.604;P<0.05). The compliance to all kinds of protection measures improved significantly (P<0.05) except compliances to equipment of hand antiseptic agent and patient transfer order (P> 0.05). Conclusion Promoting the compliance rate to hand hygiene and environmental cleaning and disinfection, primary general hospitals can decrease the detection rate and nosocomial infection case rate of MDRO.
ObjectiveTo study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.MethodsPatients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.ResultsA total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.ConclusionsThere are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.
Objective To analyze the clinical characteristics, mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii (CRAB), so as to provide references for the prevention and control of CRAB. Methods Inpatients with Acinetobacter baumannii were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital between January 2018 and December 2021. The patients were divided into CRAB infection group, carbapenem-sensitive Acinetobacter baumannii (CSAB) infection group and CRAB colonization group. Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection. Results A total of 696 patients were included. Among them, there were 392 cases of CRAB infection, 267 cases of CRAB colonization, and 37 cases of CSAB infection. The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products, mechanical ventilation, respiratory failure, maximum procalcitonin and age. Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group（χ2=4.837, P=0.028), there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk（χ2=0.219, P=0.640). Conclusions The mortality risk of CRAB infected patients is higher. Compared with the infection status, the 30-day mortality risk of patients is more attributed to drug resistance status. The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.
Objective To understand the current situation of healthcare-associated infection (HAI) in comprehensive hospitals with a number of beds≥900, and provide a reference for the next step in formulating HAI prevention and control measures. Methods The data on the prevalence rate of HAI in comprehensive hospitals with a number of beds≥900 of Yunnan Province between 2020 and 2022 were retrospective collected. The HAI situation and trend in each year were analyzed. Results A total of 119 comprehensive hospitals were included, with 166 745 patients surveyed and 3 237 cases of HAI. Lower respiratory tract infection and urinary tract infection were the most common sites. The department with the highest incidence of hospital infections was the intensive care unit, followed by neurosurgery and hematology. The prevalence rates of HAI showed a downward trend from 2020 to 2022 (2.08% vs. 1.99% vs. 1.79%, χ2=14.301, P<0.001). A total of 1 315 strains of hospital-acquired pathogens were detected, all of which were mainly Gram-negative bacteria, with Escherichia coli and Klebsiella pneumoniae being more common. The rate of antibiotics use and the rate of pathogen testing showed an upward trend from 2020 to 2022 (χ2=79.233, 23.866, P<0.001), the infection rate of incision site and the prophylactic use rate of antimicrobial drugs in patients with class Ⅰ surgery both showed a decreasing trend (χ2=15.551, 6.311, P<0.05). Conclusions The prevalence of infection in comprehensive hospitals of Yunnan Province is decreasing. But the supervision of key departments, the implementation of pathogen prevention and control measures, and the rational use of antibiotics in inpatients are still the focus of future work.