Analysis Of Drug Resistance And Risk Factors Of Nosocomial Infection Pathogens In Department Of Hematology In A Hospital

Objective: Explore the classification,specimen source,clinical characteristics,drug resistance and influencing factors of pathogenic bacteria of nosocomial infection in the department of hematology of a hospital.Provide theoretical basis for clinicians to rationally select antibacterial drugs and reduce drug resistance of pathogenic bacteria of nosocomial infection.Prevent and control infection for hospital by using scientific and effective measures.Methods: Through the retrospective analysis,with reference to the current diagnostic criteria of infection,take the patients with nosocomial infection reported to the nosocomial infection management system by the department of Hematology of the hospital from January 1,2019 to September 30,2021 as research objects,and collect the patients’ basic information,hospitalization information,infection status,risk factors,results of bacterial culture and drug sensitivity test,etc.A total of 247 strains of pathogenic bacteria of nosocomial infection were analyzed descriptively in the classification,composition and specimen origin,and were classified into gram-positive bacteria,gram-negative bacteria and fungi to analyze their clinical characteristics.According to the results of drug sensitivity test,the main pathogenic bacteria of nosocomial infection were analyzed for antibiotic resistance.The influencing factors of hospital infection of multidrug-resistant Escherichia coli and Klebsiella pneumoniae were analyzed by univariate and multivariate analysis,and the independent risk factors of infection were finally determined.Results:1.Detection of pathogenic bacteria of nosocomial infection: A total of 247 pathogenic bacteria of nosocomial infection were detected in the department of Hematology of a hospital from 2019 to 2021,including 71 gram-positive bacteria(28.7%),160 gram-negative bacteria(64.8%)and 16 fungi(6.5%).There were 56 strains(22.7%)of multidrug-resistant bacteria and 191 strains(77.3%)of non-multidrug-resistant bacteria.The top seven pathogens of nosocomial infection are:56 strains of Escherichia coli(22.7%),52 strains of Klebsiella pneumoniae(21.1%),18 strains of Staphylococcus aureus(7.3%),12 strains of narrow-feeding maltophilic lining bacteria(4.9%),11 strains of Enterococcus faecium(4.5%),9 strains of Pseudomonas aeruginosa(3.6%)and8 strains of Acinetobacter baumannii(3.2%).Most of the samples were from blood 140(56.7%),followed by sputum 52(21.1%)and secretions 27(10.9%).2.Clinical characteristics of nosocomial infection pathogens: From 2019 to 2021,the infection sites of 247 nosocomial infection pathogens corresponding to patients in the department of Hematology of a hospital were128 cases(51.8%)in blood,69 cases(27.9%)in respiratory tract and 18 cases(7.3%)in urinary tract.The mean age of patients was(49.49±17.155)years.140 cases of leukemia were diagnosed in hospital.The average length of hospitalization was(31.89±11.727)days.The average length of infection from admission was(17.27 ± 9.029)days.There were 209 cases of four or over antibiotics,52 cases of urinary tract intubation,134 cases of deep vein catheterization,192 cases of puncture,209 cases of chemotherapy,203 cases of blood transfusion,etc.3.Drug resistance of the main pathogenic bacteria of nosocomial infection: Among the pathogenic bacteria of nosocomial infection in the department of Hematology of a hospital from 2019 to 2021,there were 24 strains of multidrug-resistant Escherichia coli.The drug resistance rate of Escherichia coli to ampicillin,tetracycline,cefazolin,cotrimoxazole and piperacillin were all over 50.0%,among which ampicillin was 77.1%.The drug resistance rate to carbapenem antibiotics was less than 10.0%,and no tigecycline resistant Escherichia coli was detected.There were 25 strains of multiple drug resistant Klebsiella pneumoniae.The drug resistance rates of Klebsiella pneumoniae to cefazolin,piperacillin,ampicillin and cotrimoxazole were all more than 50.0%,among which cefazolin was the highest(59.1%).The drug resistance rate to tigecycline was the lowest(2.3%).There were two strains of multi-drug resistant Staphylococcus aureus.The highest resistance rate of Staphylococcus aureus to penicillin was 100.0%,and resistance rate of Staphylococcus aureus to ampicillin was 94.1%.Staphylococcus aureus resistant to vancomycin,cotrimoxazole,daptomycin and linezolid were not detected.4.Factors influencing hospital infection of multidrug-resistant Escherichia coli and Klebsiella pneumoniae: Univariate Logistic regression analysis showed that infection was potentially associated with year,gender,age,length of hospitalization,infection site,specimen type,antibiotics,and deep vein catheterization(P<0.2).Further multivariate Logistic regression analysis showed that male,≥60 years old,≥4 antibiotics and deep vein catheterization were independent risk factors for infection(P < 0.05).Conclusion:1.From 2019 to 2021,the pathogenic bacteria of nosocomial infection in the department of Hematology of a hospital were mainly gram-negative bacteria,and the top three pathogenic bacteria of nosocomial infection were Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus.2.From 2019 to 2021,the samples of pathogenic bacteria of nosocomial infection in the department of Hematology of a hospital were mainly from blood,sputum and secretions,and the infection sites were mainly from blood,respiratory tract and urinary tract.3.Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus,three major pathogenic bacteria of hospital infection detected in the department of Hematology of a hospital from 2019 to 2021,had a high drug resistance rate to most antibiotics,so active monitoring should be continued to provide data support for guiding clinical rational drug use and developing effective prevention and control measures.4.Male,≥60 years old,≥4 antibiotics and deep vein catheterization are independent risk factors for hospital infection of multidrug-resistant Escherichia coli and Klebsiella pneumoniae.Relevant factors should be effectively managed in combination with clinical practice to prevent and control hospital infection of multiple drug resistant bacteria.