某综合医院多重耐药菌社区发生感染的现状调查

Community-onset multi-drug resistant organism infections in a general hospital

目的了解多重耐药菌(MDROs)社区发生感染(COI)的特点。方法对某综合医院2008年7月1日—2010年6月30日所有金黄色葡萄球菌、肠球菌属、大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌培养阳性的患者进行前瞻性调查,了解MDRO-COIs情况。结果调查期间的住院患者中发生金黄色葡萄球菌、肠球菌属、鲍曼不动杆菌、大肠埃希菌和肺炎克雷伯菌感染共1 646例次,包括COIs 1 148例次,其中MDROs感染470例次,占40.94%;医院发生感染(HOI)498例次,其中MDROs感染260例次,占52.21%,显著高于MDRO-COIs的比例,差异有统计学意义(χ2=17.87,P=0.00)。MDRO-COIs病原体标本主要来源于痰或气管分泌物(36.38%,171/470),其次为尿液(35.32%,166/470),两者共占71.70%。在科室分布中,MDRO-COIs比例以重症监护室最高,达64.75%。在各COI感染部位中,呼吸系统MDROs感染比例最高,达60.71%。结论 MDRO-COIs情况严重,应加强对此类患者的管理,预防MDROs在医院内的传播。

Objective To realize lhe characterislics of community-onset multi-drug resistant organism infections （MDR（YCOIs）. Methods A prospective investigation was conducted on patients with positive culture of Staphylo- coccus aureus , Enterococcus, Escherichia coli , Klebsiella pneumoniae , and Acinetobacter baumannii between July 1, 2008 and June 30,2010. Results A total of 1 646 episodes of Staphylococcus aureus, Enterococcus, Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae infections occurred, 1 148 of which were COIs, including 470 （40. 94%） MDRO infeelions ; 498 of which were hospital-onset （HO） infections , including 260 （52. 21 %） MDRO infections, which was significantly higher than that of MDRO-COI rate （Z2 = 17.87, P = 0. 00）. MDRO- COI pathogens were mainly from sputum or bronchial secretion （1 71/470, 36. 38 %）, the next was urine（ 166/470, 35.32%）, these samples accounted for 71.70% of all. Of all departments, MDRO-COI rate was the highest in in- tensive care unil （ICU） （64. 75G）. For lhe infection sites of COIs, respiratory MDRO infection was the highest （60. 71 %）. Conclusion MDRO-COls are serious, the management of patients with MDRO-COIs should be en- hanced, transmission in the hospital should be avoided.