医院多药耐药菌监测预警模型的建立

Establishment of early warning model of surveillance of multidrug-resistant bacteria

目的了解临床医院感染多药耐药菌检出率和抗菌药物预警模型的建立,为安全合理应用抗菌药物与预防多药耐药菌的发生提供参考依据。方法收集2012-2013年临床感染患者送检标本分离出病原菌共6 185株,对其中产ESBLs大肠埃希菌、多药耐药鲍氏不动杆菌、多药耐药铜绿假单胞菌、产ESBLs肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌5种细菌通过χ2检验比较其总体差异性,多药耐药菌检出率与抗菌药物预警阳性率之间进行关联性分析,并建立回归方程的监测预警模型。结果多药耐药鲍氏不动杆菌检出及其医院感染率均最高,分别为34.20%、42.32%;多药耐药铜绿假单胞菌检出最低占1.73%,但其医院感染率较高为36.17%;产ESBLs大肠埃希菌检出占32.92%,仅次于多药耐药鲍氏不动杆菌,但其医院感染率较低为25.22%,差异有统计学意义(P<0.01)。结论对多药耐药菌进行监测,注意加强多药耐药鲍氏不动杆菌与多药耐药铜绿假单胞菌的医院感染预防控制,通过回归方程模型,能预测常用抗菌药物耐药数量,对临床合理应用抗菌药物有重要意义。

OBJECTIVE To investigate the isolation rates of multidrug‐resistant bacteria causing nosocomial infec‐tions and establish the early warning model of antibiotics so as to provide guidance for reasonable use of antibiotics and prevention of the multidrug‐resistant bacteria infections .METHODS A total of 6 185 strains of pathogens have been isolated from the infective specimens in 2012-2013 ,the chi‐square test was conducted to observe the overall difference among the five species of bacteria ,including ESBLs‐producing Escherichia coli ,multidrug‐resistant Acinetobacter baumannii ,multidrug‐resistant Pseudomonas aeruginosa ,ESBLs‐producing Klebsiella pneumoni‐ae ,and methicillin‐resistant Staphylococcus aureus ;the correlation between the isolation rate of the multidrug‐re‐sistant bacteria and the positive rate of early warning of antibiotics was analyzed ,and the surveillance early warn‐ing model of regression equation was established .RESULTS The isolation rate of the multidrug‐resistant A .bau‐mannii was 34 .20% ,the multidrug‐resistant P .aeruginosa 1 .73% ,the ESBLs‐producing E .coli 32 .92% ,rank‐ing second only to the multidrug‐resistant A .baumannii .The incidence of nosocomial infections caused by the mul‐tidrug‐resistant A .baumannii was 42 .32% ,the incidence of nosocomial infections caused by the multidrug‐resist‐ant P .aeruginosa 36 .17% ,the incidence of nosocomial infections caused by the ESBLs‐producing E .coli 25 .22%（P〈0 .01） .CONCLUSION It is of great significance to monitor the multidrug‐resistant bacteria ,focus on the con‐trol and prevention of nosocomial infections caused by the multidrug‐resistant A .baumannii and multidrug‐resist‐ant P .aeruginosa ,and establish the regression equation model to predict the number of the commonly used antibi‐otics to which the bacteria are resistant so as to reasonably use antibiotics .