住院患者多药耐药菌感染的临床分布特点与管理研究

Clinical distribution characteristics and management strategies of multidrug-resistant organism infections in inpatients

目的探讨住院患者多药耐药菌感染的临床分布特点与管理策略,为多药耐药菌感染的预防与治疗提供依据。方法选取医院2012年1月-2014年12月351例多药耐药菌感染患者临床资料,采集标本进行菌株鉴定及药敏试验。结果 351例患者送检标本共分离出375株多药耐药菌,标本来源以痰液为主188株占50.13%,其次为血液68株占18.13%;呼吸内科、ICU、肾内科、胃肠肿瘤外科是多药耐药菌检出最多的科室,分别检出多药耐药菌115、72、60、51株,分别占30.67%、19.20%、16.00%、13.6%;375株多药耐药菌中革兰阴性菌276株73.60%、革兰阳性菌99株26.40%,检出率在前5位的分别为鲍氏不动杆菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌;2012、2013、2014年多药耐药菌检出率,分别为28.80%、33.87%、37.33%,呈上升趋势。结论多药耐药菌感染呈上升趋势,应采取相应管理策略控制、预防感染,尤其对呼吸内科、ICU、肾内科、胃肠肿瘤外科等高危科室,更应该重视。

OBJECTIVE To investigate the clinical distribution and management method of multidrug-resistant organism（MDRO）infections in inpatients so as to provide reference for prevention and treatment of MDRO infections.METHODS Totally 351 cases of patients with MDRO infections in our hospital from Jan.2012 to Dec.2014 were selected and inspected for strain identification and sensitivity testing.RESULTS Totally 375 strains of multidrug-resistant organisms were isolated from 351 submitted samples,among which sputum was the main sample source（188strains,50.13%）,followed by blood（68strains,18.13%）.Respiratory medicine,ICU,nephrology,gastrointestinal surgery were the departments with higher detection rates,detected with 115 strains,72strains,60 strains and 51 strains,accounting for 30.67%,19.20%,16.00% and 13.6%,respectively.There were 276 strains of gram-negative bacteria（73.60%）and 99 strains of gram-positive bacteria（26.40%）.The top5 bacteria were Acinetobacter baumannii,Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae.The detection rate in the year 2012,2013 and 2014was 28.80%,33.87% and 37.33%,respectively.CONCLUSION Multidrug-resistant infection is on the rise,clinicians should take appropriate management strategies to control and prevent multidrug-resistant infections,especially in high-risk departments of respiratory medicine,ICU,nephrology and gastrointestinal surgery.