多药耐药菌目标性监测与分析

Targeted monitoring of multidrug-resistant bacteria

目的对肿瘤专科医院进行多药耐药菌(MDROs)目标性监测,了解多药耐药菌分布,评价干预效果,为临床合理用药提供参考依据。方法 2011年1-12月在全院临床科室开展多药耐药菌目标性监测,实施干预,包括宣教和培训、设计多药耐药菌登记本,采取接触隔离预防措施,每日通过LIS系统监测全院多药耐药菌,并到相关科室督查实施。结果共检出MDROs 65株,2011年一、二、三、四季度MDROs检出分别为12、18、23、12株,MDROs占病原菌的15.16%,主要为产ESBLs的大肠埃希菌,其次为泛耐药鲍氏不动杆菌(PDRAB)和耐甲氧西林金黄色葡萄球菌(MRSA);36.92%为痰标本,26.15%为胸、腹腔引流液;目标性监测结果显示,外科、内科MDROs明显高于其他科室,分别占46.16%和27.69%。结论临床医护人员应加强多药耐药菌感染预防与控制措施、合理使用抗菌药物、主动筛查多药耐药菌等,以降低发生多药耐药菌医院感染的风险。

OBJECTIVE To conduct a targeted monitoring of multidrug-resistant bacteria in the tumor hospital,understand the distribution of the multidrug-resistant bacteria and evaluate the intervention effect so as to guide thereasonable clinical medication. METHODS The targeted monitoring was conducted in all the clinical departmentsfrom Jan to Dec 2011 ; the intervention measures, including education and training, designing register of multidrug-resistant organism, taking contact isolation precautions, daily monitoring through LIS system,supervision ofrelated department,were carried out. RESULTS A total of 65 strains of MDROs were isolated,among which 12strains were isolated in the first season of 2011,18 strains in the second season,23 strains in the third season,and12 strains in the fourth season; the MDROs accounted for 15. 16% among the pathogens, among which theESBLs-producing Escherichia coli was dominant, followed by the pandrug-resistant Acinetobacter baumannii（PDRAB） and the methicillin-resistant Staphylococcus aureus （MRSA） ; 36. 92% of the strains were isolated fromthe sputum specimens,26. 15% from pleural or peritoneal fluid drainage. The result of the targeted monitoringrevealed that the isolation rates of MDROs in the surgery department and the internal medicine department wererespectively 27. 69 % and 46. 16% , significantly higher than other departments. CONCLUSION It is necessary forthe clinical medical staff to strengthen the prevention and control of MDROs infections, reasonably use antibiotics,and actively screen the MDROs so as to reduce the risk of MDROs infections.