医院感染多药耐药菌前瞻性干预效果研究

Effects of prospective interventions to nosocomial infections induced by multidrug-resistant organisms

目的了解医院多药耐药菌(MDROs)感染,并根据MDROs分布及药敏试验结果实施有效干预措施,指导临床合理使用抗菌药物,减少发生MDROs感染。方法采用医院感染实时监控系统前瞻性对某医院2014年1月1日-10月31日住院患者MDROs感染及菌株、药敏试验结果进行监测分析,应用WHONET5.4软件统计药敏试验数据。结果 40 334例住院患者中发生医院感染752例、907例次,感染率1.86%、例次感染率2.25%;从痰液、血液等送检标本中分离出998株病原菌,其中MDROs 308株,检出率30.86%;检出的MDROs以革兰阴性菌为主,共231株占75.00%,以鲍氏不动杆菌居为主,革兰阳性菌71株占23.05%,以金黄色葡萄球菌为主,真菌6株占1.95%;住院患者发生MDROs感染的主要病区为综合楼ICU、外科楼ICU、神经血管外科和神经创伤外科,分别占20.78%、17.53%、11.36%和9.42%。结论利用前瞻性监测医院MDROs感染,即时发现问题,针对性的采取物体表面环境、空气、手卫生监测、严格执行消毒隔离制度等现场干预措施,同时规范临床合理使用抗菌药物,可有效降低MDROs感染的发生。

OBJECTIVE To understand the prevalence of multidrug-resistant organisms（MDROs）infections and implement the effective intervention measures based on the distribution of MDROs and results of drug susceptibility testing so as to provide guidance for reasonable clinical use of antibitoics and reduce the incidence of MDROs infections.METHODS By means of the real-time monitoring system of nosocomial infections,the prospective surveillance was conducted for the patients with MDROs infections who were hospitalzied from Jan 1,2014 to Oct 31,2014,the pathogens,and the results of drug susceptiblity testings.The statistical analysis was performed for the data of the drug susceptibiy testings by using WHONET5.4software.RESULTS The nosocomial infections occurred in 752（907case-times）of 40 334 hositlaized patients,with the case-time infection rate 2.25%.A total of998 strains of pathogens were mainly isolated from the submitted sputum and blood specimens,of which 308 were MDROs,with the detection rate 30.86%.Among the isolated MDROs,there were 231（75.00%）strains of gram-negative bacteria,71（23.05%）strains of gram-positive bacteria,and 6（1.95%）strains of fungi;the Acinetobacter baumannii was the predominant species of the gram-negative bacteria;the Staphylococcus aureus was dominant among the gram-positive bacteria.Of the hosptialized patients with MDROs infections,20.78%were in the general building ICU,17.53%in the surgery buliding ICU,11.36%in the department of neurovascular surgery,9.42%in the department of neurotrauma department.CONCLUSIONIt is an effective way to conduct the prospective surveillance of MDROs infections to find out the problems in a timely manner,take targeted onsite intervention measures such as monitoring of object surfaces,air,and hand hygiene as well as implementation of rigid disinfection and isolation systems,and reasonably use antibiotics so as to reduce the incidence of MDROs infections.