2013年我院多重耐药菌的分布及耐药性分析

Analysis on Clinical Distribution Characteristic and Drug Resistance of Multi-drug-resistant Organism in our Hospital from 2013

目的:探讨多重耐药菌感染的流行特征和相关因素,为临床治疗和制订医院感染控制措施提供依据。方法:对2013年我院住院患者送检标本中分离的多重耐药菌进行统计,并对其分布情况及耐药性进行分析。结果:多重耐药菌构成比58.05%,男性患者、老年患者、呼吸道疾病、脑血管意外、颅脑损伤、恶性肿瘤和多发性外伤患者、住院时间20~30 d、秋冬季就诊的患者检出例数较多,主要分布在ICU(17.67%)、神经外科(15.82%)、呼吸内科(10.68%),主要标本来源依次为痰液(54.48%)、分泌物(11.24%)、尿液(17.91%)。各种多重耐药菌构成比不同,其中耐碳青霉烯大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、克雷伯菌属与耐万古霉素屎肠球菌、粪肠球菌均有检出,耐甲氧西林金黄色葡萄球菌构成比为74%,表皮葡萄球菌构成比72%。检出的主要多重致病菌均有不同程度的耐药性,其中革兰阴性杆菌耐药性最低的是头孢哌酮/舒巴坦,革兰阳性球菌耐药性最低的是万古霉素与利奈唑胺。培养出多重耐药菌前,大多数病例具有多种抗菌药使用史,以β-内酰胺类抗菌药最常用。结论:我院多重耐药菌感染形势严峻,应加强多重耐药菌的感染预防控制与抗菌药合理使用管理。

Objective：To investigate the prevalence of multiple drug-resistant organism （MDRO） infection char- acteristics and related factors for the development of clinical treatment and a reasonable basis for hospital infection control measures. Methods：To statistic the MDRO separated from the clinical specimens in 2013 and analyze clinical distribution characteristic and drug resistance. Results：The constituent ratio of MDRO was 58.05 %. The constituent ratio was higher in the the male patients, elderly patients, patients with respiratory disease, cerebral vascular, accident, traumatic brain inju- ry, cancer and multiple trauma, patients staying in hospital for 10-20d , patient with treatment in autumn or winter. MDRO mainly distributed in ICU（ 17.67% ）, the neurosurgery department（ 15.82% ）and respiratory department（ 10.68% ）. The main specimen sources of MDRO was sputum, secretion and urine. The different was that MDRO had different constituent ratio. Carbapenem-resistant Escherichia coli, Carbapenem-resistant Pseudomonas aeruginosa, Carbapenem-resistant Acine- tobacter baumanii, Carbapenem-resistant Pseudomonas aeruginosa, Vancomycin-resistant Enterococcus Faliscan and En- terococcus faecium were detected. The constituent ratio of methicillin-resistant Staphylococcus aureus （MRSA） was 74%, the constituent ratio of methicillin-resistant Staphylococcus epidermidis （MRSE） was 72%. The different MDRO had dif- ferent drug desistance, Cefoperazone-sulbactam were the most active antibiotic to G- , Vancomycin and Linezolid were the most active antibiotic to G ~. Before the culturing the MDRO, the all patients had history of using the antimicrobial agents, [^-Lactams antimicrobial agents was one of the most commonly used drugs. Conclusion： The drug resistance of multi-drug resistant MDRO is very serious. It is very important to select proper antibiotics according to the result of susceptibility tests. Hospital should strengthen the monitoring of MDRO to prevent and control the outbreak and prevalence of nosocomial infec- tions.