ICU患者多药耐药菌感染的监测与控制

Surveillance and control of multidrug-resistant organisms in ICU

目的加强ICU患者多药耐药菌(MDROs)感染分布及耐药性的监测与控制,使多药耐药菌医院感染控制工作规范有序。方法收集2012年1月-2013年12月医院ICU 1 735例患者送检的临床标本分离的病原菌,采用全自动微生物分析仪进行细菌鉴定及药敏试验,开展多药耐药菌目标性监测,采取干预措施控制多药耐药菌医院感染。结果 ICU 1 735例患者发生医院感染189例,医院感染率为10.9%;其中多药耐药菌感染169例,感染率9.7%;痰液、咽拭子及支气管痰液吸取物标本中分离的MDROs最多,占69.7%;380株MDROs中耐碳青霉烯类鲍氏不动杆菌最多占30.5%,其次为产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(ECO)、产ESBLs肺炎克雷伯菌(KPN)61株,分别占23.4%、16.1%;耐甲氧西林金黄色葡萄球菌(MRSA)对β-内酰胺类、氨基糖苷类、大环内酯类、喹诺酮类、利福平和四环素等抗菌药物的耐药率均显著高于耐甲氧西林凝固酶阴性葡萄球菌(MRCNS),耐碳青霉烯类铜绿假单胞菌和鲍氏不动杆菌的耐药性极强,对阿米卡星和头孢哌酮/舒巴坦的耐药率均较低。结论多药耐药菌是ICU医院感染的主要病原菌,加强ICU患者多药耐药菌监测以及采取积极的干预措施,可有效预防与控制其产生和传播。

OBJECTIVE To promote the surveillance and control of the distribution and resistance of multidrug‐re‐sistant organisms （MDROs） so as to standardize the control and prevention of hospital infections .METHODS To‐tally 735 strains of pathogens isolated from patients from Jan .2012 to Dec .2013 were collected .Identification of bacteria and antibiotic sensitivity test were performed by automated microbe analyzer .The multi‐drug resistance of bacteria was monitored .Effective control measures were adopted to control the spread of multidrug‐resistant or‐ganism .RESULTS From Jan 2012 to Dec 2013 ,189 cases in the total 735 cases were infected and the hospital infec‐tion rate was 10 .9% ,including 169 cases being infected by multi‐drug resistant bacteria and the infection rate was 9 .7% .Sputum ,throat swab and endotracheal aspirate contained most MDROs ,accounting for 69 .7% .In 380 strains of multiple drug‐resistant bacteria ,carbapenemase‐ resistant A cinetobacter baumannii held the majority , accounting for 30 .5% ,followed by ESBLs‐producing ECO and ESBLs‐producing KPN ,accounting for 23 .4% and 16 .1% .Resistance of MRSA to antibiotics was more serious than MRCNS .Carbapenems‐resistant Pseudomonas aeruginosa and A .baumannii had extremely high drug resistance ,while sensitive to amikacin and cefoperazone/sulbactam .CONCLUSION M ultidrug‐resistant organisms are the main pathogens in nosocomial infections in ICU . Monitoring of multi‐drug resistant bacteria and active preventive measures can effectively control and prevent the spread of pathogens .