某三级甲等综合医院多药耐药菌监测与预防控制研究

Surveillance of multidrug-resistant organisms in a tertiary hospital and prevention measures

目的了解某三级甲等综合医院多药耐药菌(MDROs)的检出及感染情况,探讨有效预防控制多药耐药菌医院感染发生的干预措施。方法监测2013年1-12月医院微生物室检出的所有细菌,判断是否为多药耐药菌及感染类型,并于2013年1月起采取持续性、集束化的干预措施;对比实施干预措施前后的MDROs检出率、MDROs日感染率和MDROs医院感染日感染率;采用Excel表建立数据库,对数据进行统计分析。结果 MDROs检出率、MDROs日感染率和MDROs医院感染日感染率由1月份的79.44%、4.42‰和1.08‰下降至12月份的58.59%、2.72‰及0.87‰;不同科室患者MDROs感染情况各异,中心ICU的MDROs日感染率及医院感染率最高。结论持续性、集束化的干预措施可以降低MDROs感染的风险;鲍氏不动杆菌等革兰阴性菌是医院感染主要的MDROs。

OBJECTIVE To investigate the isolation rates of multidrug-resistant organisms（MDROs）in a tertiary hospital,analyze the prevalence of the infections,and put forward effective intervention measures for the control of the MDROs infections.METHODS From Jan 2013 to Dec 2013,all the bacteria isolated from the microbial room were monitored to determine the MDROs and the types of infections.The sustained cluster intervention measures were taken since Jan 2013.The isolation rate of MDROs,daily rate of MDROs infections,and daily rate of MDROs nosocomial infections were observed and compared before and after the intervention measures were taken;the database was established by using Excel table,and the statistical analysis of data was performed.RESULTS The isolation rate of MDROs dropped from 79.44%in Jan to 58.89%in Dec;the daily rate of MDROs infections decreased from 4.42‰ in Jan to 2.72‰ in Dec;the daily rate of MDROs nosocomial infections dropped from1.08‰in Jan to 0.87‰in Dec.The incidence of MDROs infections varied in the departments;the daily rate of MDROs infections and the incidence of the nosocomial infections were the highest in the central ICU.CONCLUSIONThe sustained cluster interventions may reduce the risk of MDROs infections.The gram-negative bacteria such as Acinetobacter baumannii are dominant among the MDROs causing the nosocomial infections.