多重耐药菌的科室分布及院内感染控制

Department distribution of multidrug-resistant organisms and the infection control of some hospital

目的探讨常见多重耐药菌(MDROs)科室分布特征,寻找有效措施控制多重耐药菌医院感染的发生。方法采用回顾性分析方法,对2015年1-9月医院住院患者耐甲氧西林金黄色葡萄球菌(MRSA)、多重耐药鲍曼不动杆菌(MDR-AB)、多重耐药铜绿假单胞菌(MDR-PA)、耐碳青霉烯类的肠杆菌科细菌(CRE)及耐万古霉素肠球菌(VRE)感染的患者进行调查,分析其来源及科室分布特征。结果常见多重耐药菌感染452例,其中属于医院感染222例,占49.12%,属于社区感染230例,占50.88%。分布于33个病区,主要分布在综合ICU、烧伤整形科、皮肤科和小儿内科,构成比分别为29.65%、11.50%、6.42%、5.09%。多重耐药菌检出率由高到低依次为:MRSA(209株,占46.24%)、MDR-AB(159株,占35.18%)、MDR-PA(56株,占12.39%)、CRE(28株,占6.19%)、VRE(0株,占0%)。结论多重耐药菌来源于社区或医院内,科室分布广,有分类聚集现象,不同科室院内感染控制侧重点应有不同。

Objective To explore the distribution characteristics of multidrug- resistant organisms（ MDROs） in our hospital so as to find effective measures to control hospital infection of MDROs. Methods Retrospective analysis was adopted to investigate the profile of Methicillin- resistant Staphylococcus aureus（ MRSA）,Multidrug- resistant Acinetobacter baumannii（ MDR- AB）,Multidrug- resistant Pseudomonas aeruginosa（ MDR- PA）,Carbapenem- resistant Enterobacteriaceae（ CRE） and Vancomycin resistant Enterococci（ VRE） infection according to the culture of microorganisms among patients in our hospital from January to September,2015. The derivation and distribution characteristics of MDROs were also analyzed. Results Among the total 452 common MDROs infection cases,222 cases accounting for 49. 12% were hospital infection,while 230 cases（ 50. 88%） were community infection. The total cases of MDROs in hospital infection were distributed in 33 different wards,mainly in general Intensive Care Units（ 29. 65%）,department of burn and plastic surgery（ 11. 05%）,department of dermatology（ 6. 42%）,and department of pediatric internal medicine（ 5. 09%）. The percentage composition of MDROs including MRSA,MDR- AB,MDR- PA,CRE,and VRE were 46. 24%（ 209 strains）,35. 18%（ 159 strains）,12. 39%（ 56 strains）,6. 19%（ 28 strains）,and 0%（ 0 strain）,respectively. Conclusion MDROs derive from both community and hospital with a wide range of department distribution and different organisms gathering properties. Different strategies in various departments should be emphasized in hospital infection control.