了解和掌握医院感染状况和变化趋势，为医院感染预防和控制重点提供参考依据。

对青海省心脑血管病专科医院2012年至2017年93 014例住院患者的医院感染发生率、感染部位分布、病原微生物分布及临床用药情况进行回顾性分析。

共监测住院患者93 014例，发生医院感染1 440例，平均医院感染率为1.5%。医院感染率较高的前5个科室依次为ICU（5.1%，103/ 2 017）、心外科（3.4%，198/5 847）、血管外科（1.9%，105/5 613）、心律失常一科（1.8%，191/10 384）和急诊科（1.8%，60/3 412）。2012年至2017年发生医院感染各部位构成比差异有统计学意义（χ² = 1 861.181、P < 0.001）。卡方趋势检验显示下呼吸道感染率（χ² = 12.653，P < 0.001）呈逐年上升趋势，泌尿系统（χ² = 17.710、P < 0.001）和皮肤软组织感染率（χ² = 5.738、P = 0.017）呈显著下降趋势，差异均有统计学意义。ICU病房下呼吸道感染率最高（70.0%，72/103），其次为心律失常二科（50.0%，28/56）；冠心病一科、冠心病三科、胸外科、神经内科和急诊科下呼吸道感染率均高于40.0%。手术部位感染率居前3位的科室分别为血管外科（29.5%，31/105）、心外科（29.3%，58/198）和冠心病二科（15.9%，27/170）。医院感染病原体中革兰阴性菌占66.4%（284/428），革兰阳性菌占28.7%（123/428），真菌占4.9%（21/428）。医院感染居前5位的病原体依次为鲍曼不动杆菌（23.6%，62/263）、金黄色葡萄球菌（20.5%，54/263）、阴沟肠杆菌（19.8%，52/263）、肺炎克雷伯菌（18.3%，48/263）和大肠埃希菌（11.0%，29/263）。医院感染多重耐药菌以耐碳青霉烯类鲍曼不动杆菌（CRAB）检出率最高，自2012年的8.3%逐年上升到2017年的30.0%；其次为耐甲氧西林金黄色葡萄球菌（MRSA），检出率自2012年的11.1%上升到2017年的28.6%。2012年至2017年本院发生医院感染者治疗使用抗菌药物主要以单联用药为主（70.3%，1 013/1 440），其次为二联用药（26.0%，374/1 440），三联或以上用药使用率为3.7%。

以感染防控为重点，开展主动监测，规范标准操作规程，严格无菌操作，有效合理使用抗菌药物是降低医院感染率的有效手段。

To investigate the status and trends of nosocomial infection in cardiovescular and cerebrovascular disease specialist hospital at altitude, and to provide references for prevention and control of nosocomial infection.

The incidence of hospital infection rate, the distribution of infection sites, the distribution of pathogenic microorganisms and the use of antibiotics of 93 014 cases in Qinghai Cardio-Cerebro-Vescular Special Hospital from 2012 to 2017 were analyzed, retrospectively.

A total of 93 014 incharged patients were collected, among whom, 1 440 cases occurred nosocomial infection, with the average infection rate of 1.5%. The top five departments of nosocomial infection rate were Intensive Care Unit (5.1%, 103/2 017), Cardiac Surgery Unit (3.4%, 198/5 847), Vascular Surgery Unit (1.9%, 105/5 613), Arrhythmia Unit (1.8%, 191/10 384) and Emergency Unit (1.7%, 60/3 412). There was significant difference in the infection rates of nosocomial infection sites from 2012 to 2017 (χ² = 1 861.181, P < 0.001). The chi-square trend test showed that the rate of the lower respiratory tract infection increased by years (χ² = 12.653, P < 0.001), and the infection rates of urinary system (χ² = 17.710、P < 0.001) and mucous membrane (χ² = 5.738、P = 0.017) decreased by years. The rate of lower respiratory tract infection at ICU Ward was the highest, accounting for 70% (72/103), followed by Arrhythmias 2nd Unit, accounting for 50% (28/56). The lower respiratory infection rates of Chest Surgery, Coronary Heart Disease 1st Unit, Coronary Heart Disease 3rd Unit, Emergency Department and Neurology Department were all above 40%. The rate of surgical site infection at Vascular Surgery Unit (29.5%, 31/105) and Cardiac Surgery (29.3%, 58/198) were both higher than others, following by Coronary Heart Disease 2nd Unit, accounting for 15.9% (27/170). The distribution of nosocomial pathogenic microorganisms were Gram-negative bacteria, which accounted for 66.4% (284/428), Gram-positive bacteria accounted for 28.7% (123/428) and fungi accounted for 4.9% (21/428). Acinetobacter baumannii (23.6%, 62/263), Staphylococcus aureus (20.5%, 54/263), Enterobacter cloacae (19.8%, 52/263), Klebsiella pneumoniae (18.3%, 48/263) and Escherichia coli (11.0%, 29/263) were the main five pathogens of nosocomial infection. Methicillin-resistant Staphylococcusaureus (MRSA) was with the highest detection rate among multiple drug-resisitant bacteria, which increased from 11.1% to 28.6% from 2012 to 2017. The use of antibiotics in the treatment of patients with nosocomial infection consisited of single drug for 70.3% (1 013/1 440), two-drug for 26.0% (374/1 440) and three-drug for 3.7% (53/1 440).

It was an effective way to reduce nosocomial infection to focus on the prevention and control of infection, active monitoring, standardizing the operating procedures, operating strictly in the aseptic technique and using the anti-bacterial drugs effectively and reasonably.