某医院ICU多重耐药菌的流行病学特点及预防措施

Epidemiological characteristics and preventive measures of multidrug- resistant organisms in ICU of a hospital

目的了解重症医学科(ICU)患者多重耐药菌(MDRO)的检出情况及分布特点,为预防MDRO的传播提供依据。方法收集2012年1月-2013年12月某医院ICU住院患者送检的各类临床标本培养出的MDRO。分析MDRO感染的流行病学特点、阳性标本分布、检出MDRO的时间分布特点分析。结果 2年ICU共入住1 839例患者,216例患者共检出MDRO 315株,检出率为11.7%。常见的MDRO依次是鲍曼不动杆菌(MDR-AB)、大肠埃希菌(ESBLs)、肺炎克雷伯菌(ESBLs)和金黄色葡萄球菌(MRSA)等。首次标本培养耐药共117株;首次培养阴性,数天后培养出耐药菌共110株;首次培养为其他菌种,数天后培养出不同菌种的耐药菌共计66株;开始培养出该菌种不耐药,隔一段时间后该细菌耐药共计22株。住院时间和年龄是患者感染或定植MDRO的危险因素。结论为减少MDRO的感染或定植,尽可能及时将患者转出ICU,减少患者入住ICU的时间,严格执行手卫生、病房环境消毒隔离措施,合理使用抗菌药物。

Objective To understand the detection rate and distribution characteristics of Intensive Care Unit（ ICU） patients with multidrug- resistant organisms（ MDRO） so as to provide the basis for prevention MDRO transmission. Methods All kinds of clinical specimens from January 2012 to December 2013 in our hospital ICU patients developed MDRO were retrospectively collected. The epidemiological characteristics of MDRO infection,distribution of ICU positive samples with MDROs in two years and time distribution characteristic were analyzed. Results 1 839 patients were stay in ICU from 2012- 2013,and 216 patients were detected with MDRO of 315 strains,and the detection rate was 11. 7%. The most common MDRO were Acinetobacter baumannii（ MDR- AB）,Escherichia coli（ ESBLs）,Klebsiella pneumoniae（ ESBLs）,Staphylococcus aureus（ MRSA） and so on. Totally 117 strains were cultured positive for the first time; a total of 110 drug- resistant strains were cultured negative for the first time,after a few days to be cultured positive; totally 66 strains were initial trained for other species,after the number of days to be trained for different strains of drug- resistance; 22 strains bacteria were cultured positive with no resistance while to be drug resistance after intervals. The length of stay,age were risk factors for patient infection or colonization MDRO. Conclusion To reduce patient MDRO infection or colonization,patients should be as promptly as possible transferred out of ICU. Reducing the time patients admitted to the ICU,the implementation of strict hand hygiene,disinfection and isolation measures to ward environment,rational use of antibiotics are necessary.