泛耐药鲍氏不动杆菌感染相关因素分析

Related factors for pandrug-resistant Acinetobacter baumannii infections and nursing interventions

目的探讨泛耐药鲍氏不动杆菌(PDRAB)医院获得性感染的相关危险因素及干预措施。方法收集江山市人民医院2009年1月-2011年12月医院感染流行分离的PDRAB 58株及临床资料;用纸片琼脂扩散法检测其对14种抗菌药物的耐药性,重复序列PCR(REP-PCR)对流行菌株进行基因水平鉴定。结果 58株泛耐药鲍氏不动杆菌对14种抗菌药物均耐药;8例PDRAB患者中,感染部位以肺部感染为主,44例占75.9%,其次为血流和颅内感染,分别占10.3%和6.9%;发生感染科室以ICU为主,36例占62.1%,58株PDRAB REP-PCR检测分为11个基因型,其中A型19株,为主要流行型别;住院时间≥2周、有ICU入住史、有机械通气等侵入性操作及广谱抗菌药物使用时间≥2周是PDRAB医院获得性感染的危险因素(P<0.05);患者周围环境、呼吸机及呼吸机管道和医护人员的手携带PDRAB是引起交叉感染造成集中暴发的重要原因。结论医院内获得性鲍氏不动杆菌对多种抗菌药物的耐药性极高,且泛耐药率增加较快,早期识别和隔离传播者、加强环境器械消毒和医护人员手卫生、实施有效的消毒隔离措施,规范抗菌药物的使用是控制医院获得性感染的关键因素。

OBJECTIVE To investigate the related risk factors for hospital-acquired infections caused by pandrug- resistant Acinetobacter baumannii （PDRAB） and put forward appropriate nursing interventions. METHODS A total of 58 strains of PDRAB isolated from Jiangshan People% Hospital from Jan 2009 to Dec 2011 were collected, then the paper disc agar diffusion method was used to test the drug resistance of the isolates to 14 antibiotics, the gene level identification for the prevalent strains was conducted with repetitive sequence PCR （REP-PCR）. RESULTS All the 58 strains of PDRAB were resistant to the 14 antibiotics. Of 8 cases of PDRAB infections, there were 44 （75. 9%） cases of pulmonary infections, which were dominant, followed by the cases of bloodstream infections （10.3 % ） and the cases of intracranial infections （6.9 % ）. There were 36 （62.1 % ） cases of irlfections in ICU. Totally 11 genotypes have been detected in the 58 strains of PDRAB through REP-PCR, among which the type A was the most prevalent type （19 strains）. The length of hospitalization more than two weeks, history of ICU stay, invasive operations such as mechanical ventilation, and use of broad spectrum antibiotics more than two weeks were the risk factors for the hospital-acquired infections caused by the PDRAB（P〈0.05）; the surroundings, ventilator, tubes of ventilator, and medical staff＇s carrying PDRAB were the leading causes of outbreak of cross infections. CONCLUSION The A. baumannii strains casing hospital-acquired infection, s are highly resistant to a variety of antibiotics, and the pandrug-resistance rate is increased rapidly. To identify and isolate the disseminator in early stage, enhance the disinfection of instruments and environment and the hand hygiene of medical staff, implement effective disinfection and isolation measures, and standardize the use of antibiotics is crucial to the control of the hospital-acquired infections.