地震受伤患者病原菌感染临床分析及对策

Resistant Bacteria Infection in Earthquake Casualty:Clinical Analysis and Countermeasure

目的掌握地震受伤患者病原菌感染情况,为减少或杜绝病原菌在医院的传播提供依据。方法感染控制办公室专业人员对38例病原菌感染地震受伤患者病原菌培养报告进行每天监控;建立地震受伤患者病原菌感染管理制度与措施,并现场监督、指导、检查其落实情况。结果地震受伤患者共送检标本419份,检测出病原菌70株,G-菌占97.1%,主要是鲍氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌、肺炎克雷伯菌、大肠埃希菌等;感染部位以呼吸道和伤口为主;病原菌对临床常用的三、四代头孢菌素、氨基糖苷类、磺胺类、喹诺酮类均表现出高度的耐药性,仅有极少数菌株对阿米卡星、庆大霉素、亚胺培南、哌拉西林/他唑巴坦、复方新诺明、妥布霉素、呋喃妥因敏感。结论对地震受伤患者进行病原菌感染的实时监控,能及时发现感染受伤患者,并采取有效干预措施,是预防与控制耐药菌造成医院感染的重要手段。

OBJECTIVE To understand the resistant bacteria infection condition of earthquake casualty and provide evidence for reducing their transmission in hospital. METHODS The staff members of Department of Hospital Infection Management monitored the bacteria cultures and report 38 resistant bacteria infective wounded every day. Set up the system measures to manage resistant bacteria infection of earthquake casualty and monitored, guided and checked the implement countermeasures. RESULTS Among 419 samples, there were 70 resistant bacteria and 97.1 % were G^- bacteria, the main pathogens were Acinetobacter baumannii, Pseudornonas aeruginosa , Enterobacter cloacae, Klebsiella pneumoniae , and Escherichia coli. The main infective sites were respiratory tract and wounds. The resistant bacteria had the high drug resistance to the third and fourth cephalosporins, aminoglycosides and sulfonamides. The sensitive rate to amikacin, gentamicin, imipenem, piperacillin/ tazobactam, sulfamethoxazole/trimethoprim compound, tobramycin and nitrofurantoin. CONCLUSIONS Real-time monitoring the earthquake casualty with resistant bacteria infection can find the infective wounds in time and make effective intervention measures. It is the important method to prevent and control the hospital infection.