耐碳青霉烯类鲍氏不动杆菌感染医院内流行现状与预防控制

Current status of epidemiology of carbapenems-resistant Acinetobacter baumannii infections and effectiveness of infection control

目的了解耐碳青霉烯类鲍氏不动杆菌(CR-ABA)感染医院内流行现状,探讨CR-ABA医院感染预防控制措施。方法前瞻性调查2011年1月-2012年12月住院患者感染鲍氏不动杆菌(ABA)情况,判断其感染类型及分析CR-ABA感染特征,采取感染预防控制措施,并观察其效果。结果共调查ABA感染患者258例次,其中CR-ABA院内感染192例,占74.42%,发生在ICU 116例,占全院的60.42%,下呼吸道CR-ABA感染147例,占感染的76.56%;2011-2012年社区感染率从0.67/千出院例数升高至1.20/千出院例数,而医院感染率从0.77/万住院日数降至0.71/万住院日数,社区感染显著升高而医院感染有所下降。结论 CR-ABA预防控制形势严峻,ICU为预防控制重点部门,下呼吸道感染为主要的预防控制感染部位,感染综合预防控制措施有效。

OBJECTIVE To understand the current status of epidemiology of carbapenems-resistant Acinetobacter baurnannii （CR-ABA） infections so as to prevent and control the CR-ABA infections. METHODS A prospective survey was carried out for the patients with Acinetobacter baumannii （ABA） infections from Jan. 1, 2011 to Dec 31, 2012. The types of the infections were determined, the characteristics of the CR-ABA infections were analyzed, the measures of the infection control were adopted, and the effects were observed. RESULTS of totally 258 case-times of ABA infections patients investigated, there were 192 （74.42 %） case-times of patients with CR- ABA infections, among which 116 （60. 42%） case-times of patients were from the ICU. There were 147 （76.56%） cases of patients with CR-ABA lower respiratory tract infections. The incidence of community-acquired infections was significantly higher in 2012 than that in 2011, increasing from 0. 67X0 to 1. 20%, however, the incidence of the nosocomial infections decreased from 0.77X0 to 0.71%, the incidence of the community-acquired infections was significantly increased, while the incidence of the nosocomial infections was decreased. CONCLUSION The situation of the control of CR-ABA infections is severe in the hospital. We should focus on ICUs, the lower respiratory tact is the predominant infection site; it is an effective way to take integrated control measures.