某三级综合医院多重耐药菌临床分布

Clinical distribution of multidrug-resistant organisms in a comprehensive hospital

目的了解某院多重耐药菌的临床分布特点,以采取针对性的预防控制措施。方法回顾性分析该院2012年1月1日—12月31日检出的891株多重耐药菌监测资料。结果 891株多重耐药菌中,以产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌居首位(342株,38.39%),其次为产ESBLs肺炎克雷伯菌(195株,21.89%)、多重耐药鲍曼不动杆菌(185株,20.76%)、耐甲氧西林金黄色葡萄球菌(138株,15.49%)、多重耐药铜绿假单胞菌(27株,3.03%)、产ESBLs奇异变形杆菌(2株,0.22%)、产ESBLs产酸克雷伯菌(2株,0.22%);主要集中在综合重症监护室(ICU;163株,18.29%)、神经内科(136株,15.26%)、普通外科(103株,11.56%)、神经外科(85株,9.54%)和呼吸内科(71株,7.97%)。痰标本分离多重耐药菌最多的是多重耐药鲍曼不动杆菌(242株,50.63%),主要集中在综合ICU;尿标本分离最多的是产ESBLs大肠埃希菌(141株,80.57%),主要集中在神经内科和泌尿外科。结论该院多重耐药菌感染部位主要为下呼吸道和泌尿系统;应加强对高危科室和易感人群的监控,制定有针对性的预防控制措施,遏制多重耐药菌的感染和传播。

Objective To realize the characteristics of clinical distribution of multidrug-resistant organisms （MDRO）in a hospital,and take specific measures for the prevention and control of infection.Methods Surveillance data of 891 MDR isolates detected in a hospital between January 1 and December 31,2012 were analyzed retrospec-tively.Results Of 891 MDR isolates,extended-spectrumβ-lactamase （ESBL）-producing Escherichiacoli ranked first（342,38.39% ）,followed by ESBL-producing Klebsiellapneumoniae（195,21.89% ）,MDRAcinetobacterbau-mannii（185,20.76% ）,methicillin-resistantStaphylococcusaureus（138,15.49% ）,MDRPseudomonasaeruginosa （27,3.03% ）,ESBL-producingProteusmirabilis（2,0.22% ）,and ESBL-producing Klebsiellaoxytoca（2,0.22% ）;Bacteria mainly concentrated on general intensive care unit（ICU）（163,18.29% ）,department of neurology（136, 15.26% ）,general surgery（103,11.56% ）,neurosurgery（85,9.54% ）,and respiratory diseases department（71, 7.97% ）.The most common bacteria isolated from sputum was MDR Acinetobacterbaumannii（242,50.63% ）,and mainly concentrated on general ICU;the most common bacteria isolated from urine was ESBL-producing Escherich-iacoli（141 ,80.57% ）,mainly concentrated on the departments of neurology and urology. Conclusion MDRO infec-tion in this hospital mainly concentrate on lower respiratory tract and urinary system. Monitor on high-risk depart-ments and vulnerable patients should be intensified,targeted preventive measures should be stressed to curb MDRO infection and spread.