军人患者住院前后肠道内多重耐药革兰阴性杆菌定植率的对比分析

Contrast Analysis of Multidrug Resistant Gramnegative Bacteria Colonization Rate in the Intestinal Tract of Military Patients before and after Hospitalization

目的了解军人住院前后肠道内多重耐药革兰氏阴性杆菌定植率以及药敏情况,分析军队医院内获得性多重耐药菌(multidrug resistant bacteria,MDRB)定植的危险因素,为控制MDRB在军队内传播提供资料。方法军人患者320例分别在住院后24h内和出院前24h内留取粪便标本,进行革兰氏阴性杆菌培养、鉴定和药敏试验。产超广谱β-内酰胺酶(extenden spectrum beta-lactamase,ESBLs)阳性菌以及对3种以上抗生素耐药菌均确认为MDRB。然后对医院内获得性MDRB定植患者进行危险因素分析。结果 320例患者,MDRB定植率住院后(142/320,44.38%)明显高于住院前(56/320,17.5%),两者比较差异具有统计学意义(χ2=54.08,P=0.000)。住院后和住院前定植MDRB对常用抗生素的耐药性都很高,仅对头孢哌酮/舒巴坦、阿米卡星、亚胺培南3种药物的敏感性>80%。医院内获得性MDRB定植与抗生素联用(≥2种)、住院时间(≥12 d)、病室环境MDRB阳性、ICU病房入住有关(P<0.05),而住院时间(≥12 d)、病室环境MDRB阳性是住院后获得性MDRB定植的独立危险因素。结论军人住院可使MDRB定植率显著升高,必须采取加强军人病室消毒管理,积极治疗缩短住院时间等手段控制军人医院内获得性MDRB定植。

Objective To investigate the colonization rate and the drug resistance of multidrug resistant bacteria（MDRB）in the intestinal tract of military patients before and after hospitalization and analyzed the risk factors of MDRB colonization in the intestinal tract of military patients after hospitalization treatment.Methods The fecal samples of 320 military patients before and after hospitalization were collected,cultured,identified,and the drug sensitivetest was analyzed.Extenden spectrum beta-lactamase（ESBLs）positive bacteria and resisted to three or more antibiotics were MDRB.For those patients whose MDRB were acquired in the hospital,the risk factors were analyzed.Results The MDRB colonization rate of military patients before hospitalization was 17.5%,which was lower than that after hospitalization（44.38%,χ2=54.08,P=0.000）.The drug resistance rates of all MDRB were very high,but amikacin,cefoperazone/sulbactam and imipenem＇s sensitive rates were more than80%.The hospital acquired MDRB colonization of military patients was correlated with the combination antibiotics（≥2 categories）,length of stay（≥12 days）,ward environment MDRB positive and ICU availability.Length of stay（≥12days）and ward environment MDRB positive were independent risk factors.Conclusion The hospitalization can elevated the colonization rate of military patients,and strengthening sterilization and administration of shortening the length of stay,can controll MDRB colonization rate.