医院与社区多药耐药菌感染特点分析

Characteristic of Multidrug Resistant Organisms in Hospital and Community-acquired Infection

目的了解医院获得性(HAP)与社区获得性(CAP)多药耐药菌(MDROs)感染特点,为临床有针对性地采取治疗及控制措施提供科学依据。方法对医院2008年6月-2009年5月住院患者发生金黄色葡萄球菌、肠球菌属、鲍氏不动杆菌、大肠埃希菌及肺炎克雷伯菌感染者进行调查,分析多药耐药菌感染的特点。结果共调查感染病例929例次,MDROs感染检出率为39.5%;HAP-MDROs及CAP-MDROs感染检出率分别是51.4%及35.6%,HAP-MDROs感染显著高于CAP-MDROs感染(χ2=19.2P=0.00);CAP-MDROs占MDROs检出总数的64.0%;不同科室HAP-MDROs及CAP-MDROs感染分布存在一定差异;不同MDROs来源不同,MRSA、产ESBLs肺炎克雷伯菌及PDR-AB主要来源于痰或气管分泌物;产ESBLs大肠埃希菌主要来源于社区感染的泌尿生殖道标本。结论了解HAP-MDROs及CAP-MDROs感染特点,对于细菌感染性疾病的治疗及经验选用抗菌药物具有重要的参考意义;CAP-MDROs感染检出率高使MDROs控制难度增加。

OBJECTIVE To investigate the characteristic of multidrug resistant organisms （MDROs） in hospital or community-acquired infection, so that it can approach effective infection management. METHODS Patients infected by Staphylococcus, Enterococcus, Escherichia coli, Klpneumoniae and A. baumanni were investigated in a Hospital from June 2008 to May 2009. RESULTS Among total 929 strains of bacilli from patients, 367 were MDROs infection, the detection rate of MDROs, CA-MDROs or HA-MDROs was 39. 5%, 35. 6% and 51.4% respectioety infection; The detection rate of MDROs from HAI patients was significantly higher than that from CAI patients （χ^2 = 19. 2 P = 0. 00）. There were differences between HA-MDROs and CA-MDROs in different departments. MRSA, ESBLs-kp And PDR-AB were isolated mostly from sputum of patients, and ESBLs E. coli mostly from urine of CAI patients. CONCLUSIONS It is important to analyze the characteristic of HA-MDROs or CA-MDROs in the treatment of infection or use of antibiotics from experience. MDROs control is full of difficulties as a result of high CA-MDROs rates.