全国多中心ICU抗菌药物使用与多药耐药菌监测分析

Use of antibiotics in multi-center ICU and surveillance of multidrug-resistant organisms in China

目的通过加强多药耐药菌(MDROs)监测及抗菌药物使用的管理,了解其对MDROs检出及感染的影响,为控制病原菌耐药提供参考依据。方法对2013年10月-2014年9月我国多地区46所医院进行调查,使用统一的监测方法、调查表,经过统一培训,对抗菌药物使用强度及MDROs检出资料进行分析。结果共监测患者34 081例,住院日302 818d;MDROs检出率以鲍氏不动杆菌最高,为44.08%,其次为金黄色葡萄球菌,检出率为28.02%;MDROs检出率较低的病原菌为肠球菌属、大肠埃希菌;抗菌药物使用强度较高的地区为华北及西南(DDD>163),较低的为华东(DDD=114.13);通过加强MDROs监测及预防控制,MDROs检出率显著降低(χ2=45.109,P<0.001);医院感染MDROs株数与抗菌药物使用强度均呈下降趋势,二者有明显相关性(相关系数=0.864,P=0.01)。结论通过加强MDROs监测及控制,加强抗菌药物使用管理,可有效减少MDROs医院感染的发生。

OBJECTIVE To strengthen the surveillance of multidrug-resistant organisms（MDROs）and management of antibiotics administration and understand the influence on isolation of MDROs so as to provide guidance for control of drug resistance of the pathogens.METHODS A total of 46 hospitals from multiple regions of China were investigated from Oct 2013 to Sep 2014.The unified surveillance method and questionnaire table were employed,the unified training was conducted,and the antibiotics use intensity and the data of isolation of MDROs were analyzed.RESULTS Totally 34 081 patients were monitored,with the length of hospital stay of 302 818 days.Among the isolated MDROs,the isolation rate of Acinetobacter baumannii was highest（44.08%）,followed by the isolation rate of Staphylococcus aureus（28.02%）,and the isolation rates of Enterococcus spp and Escherichia coli were low.The antibiotics use intensity was relatively high in the north and southwest China,with the DDD more than163,it was relatively low in east China,with the DDD 114.13.The isolation rate of MDROs was significantly reduced through the enhancement of surveillance,control,and prevention of MDROs（χ^2=45.109,P〈0.001）.Both the number of MDROs isolates causing nosocomial infection and the antibiotics use intensity showed downward trend and were highly correlated,with the correlation coefficient of 0.864,P=0.01.CONCLUSION It is an effective way to strengthen the surveillance and control of the MDROs and intensify the management of antibiotics administration so as to reduce the incidence of nosocomial infection due to the MDROs.