多药耐药菌感染目标性监测效果分析

Effect of targeted monitoring of multidrug-resistance bacteria infections

目的评价目标性监测对控制多药耐药菌感染的效果,为有效控制多药耐药药菌感染提供依据。方法将开展目标性监测前的2010年1-6月和开展目标性监测后的2011年同期住院患者多药耐药菌检出结果进行分析和比较。结果 2010年1-6月检出多药耐药菌134株,占总检出细菌数的7.35%,2011年同期检出68株,占比下降为4.02%,两者间差异有统计学意义(χ2=17.9125,P<0.05);开展目标性监测前后,ICU检出多药耐药菌株数分别占该期间总耐药株数的52.24%和67.65%,目标性监测对非ICU科室降低多药耐药菌感染率的影响更大(χ2=4.3804,P<0.05);约90.0%的多药耐药菌株分离自医院感染患者,约90.0%的多药耐药菌株分离自痰标本;部分革兰阴性菌的分布呈现明显的科室聚集性;主要检出细菌是多药耐药/泛耐药鲍氏不动杆菌。结论目标性监测可明显降低多药耐药菌感染率,特别是非ICU科室的多药耐药菌感染率;对ICU重点感染菌多药耐药/泛耐药鲍氏不动杆菌应采取综合的控制措施。

OBJECTIVE To evaluate the effect of targeted surveillance on the control of multidrug-resistant organism（MDRO） infections so as to provide basis for effective control of MDRD infections.METHODS The detection of the MDRO before（from Jan to Jun 2010） and after（from Jan to Jun 2011） conducting the targeted monitoring was analyzed and compared.RESULTS A total of 1824 strains of pathogens were isolated from the patient′s specimens before the targeted surveillance,among which there were 134（7.35%） strains of MDRO,totally 1691 strains of pathogens were isolated after the targeted surveillance,among which there were 68（4.02%） strains of MDRO,the difference was statistically significant（χ2=17.9125,P0.05）.The MDRO,isolated from ICU before and after the targeted surveillance,accounted for 52.24% and 67.65%,respectively.The targeted monitoring could impact,more significantly,on decreasing the incidence of MDRO infections in the non-ICU departments（χ2=4.3804,P0.05）.About 90% of MDRO strains were isolated from the patients with nosocomial infections,and about 90.00% of MDRO strains were isolated from the sputum specimens.Some of the gram-negative bacteria aggregated obviously in some departments.The main species of bacteria detected were multidrug-resistant or pan-drug resistant Acinetobacter baumannii.CONCLUSION The targeted surveillance can significantly reduce the incidence of MDRO infections,especially the incidence in the non-ICU departments.It is necessary to take comprehensive control measures to prevent multidrug-resistant or pan-drug resistant A.baumannii in ICU.