医院感染多药耐药菌的监测研究

Monitoring of nosocomial infections and multidrug-resistant bacteria

目的监测感染科病房医院感染多药耐药菌患者资料,为加强多药耐药菌的管理、规范抗菌药物的使用、有效预防医院感染提供指导依据。方法回顾性分析2010年1月-2012年12月感染科收治的感染患者284例临床资料,采用法国生物梅里埃公司提供的API微生物快速鉴定系统进行细菌鉴定,药敏试验采用K-B纸片扩散法,按照2010年CLSI抗菌药物敏感试验法规的相关判定进行药敏试验分析,将所得数据采用SPSS15.0软件进行分析,探讨多药耐药菌和医院感染的特点。结果 284例感染患者共检出多药耐药菌345株;送检标本中以痰液检出病原菌最多221株占64.06%,其次为咽拭子61株占17.68%;痰液标本检出泛耐药鲍氏不动杆菌、耐甲氧西林金黄色葡萄球菌分别占55.20%、32.13%;2010-2012年多药耐药菌检出率呈逐年递增趋势,差异有统计学意义(P<0.05);在检出的345株多药耐药菌中有53株属于医院感染,占15.36%;在导致医院感染的病原菌中以泛耐药鲍氏不动杆菌最多,耐甲氧西林金黄色葡萄球菌次之,分别占25.68%、11.71%。结论通过细菌培养及药敏试验对多药耐药菌及医院感染病例进行监测,有助于发现感染科多药耐药菌及医院感染发病特点,对于指导临床治疗和加强对多药耐药菌的管理具有重要意义。

OBJECTIVE To strengthen the management of multidrug-resistant bacteria and standardize the use of antibiotics through the monitoring of the multidrug-resistant bacteria and the cases of nosocomial infections in wards of department of infectious diseases so as to provide guidance for effective prevention of nosocomial infections. METHODS The clinical data of 284 cases of infections who were treated in the department of infectious diseases from Jan 2010 to Dec 2012 were retrospectively analyzed, then the bacteria were identified by means of API rapid identification system provided by BioM6rieux, France, the drug susceptibility testing was performed by using K-B disk diffusion method, the results were determined according to the specifications of CLSI, 2010, the obtained data were statistically analyzed wit the use of SPSS15. 0 software, and the characteristics of the multidrug-resistant bacteria and the nosocomial infections were explored. RESULTS A total of 345 strains of multidrug-resistant bacteria have been isolated from 284 cases of infections, among which 64.06% （221 strains） were isolated from the submitted sputum specimens, 17.68~ （ 61 strains ） from the throat swab~ the pandrug- resistant Acinetobacter baumannii strains isolated from the sputum specimens accounted for 55. 20~, and the methieillin-resistant Staphylococcus aureus （MRSA） strains accounted for 32. 13M. The detection rate of the multidrug-resistant bacteria showed an upward trend during 2010-2012, with statistical significance （P^0.05）. Of the 345 strains of multidrug-resistant bacteria isolated, 53 strains have caused the nosocomial infections, accounting for 15. 36~. The pandrug-resistant A. baumannii was dominant among the pathogens causing the nosocomial infections, accounting for 25.68%, followed by the MRSA （ 11.71 G）. CONCLUSION The monitorin g of the multidrug-resistant bacteria and the cases of nosoeomial infections through bacterial culture and drug susceptibility testing may facilitate the detection of the multidrug-resistant bacteria and the understanding of characteristics of onset of nosocomial infections, which has great significance in guidance of clinical treatment andmanagement of the multidrug-resistant bacteria.