骨科住院患者医院感染多重耐药菌分布及耐药性分析

Distribution and drug resistance of multidrug-resistant bacteria of hospitai infections in orthopedics patients

目的了解医院骨科住院患者医院感染多重耐药菌分布及耐药性,为临床合理应用抗菌药物提供科学依据。方法采用回顾性调查方法,对某部队医院骨科146例住院患者感染多重耐药菌种类分布及耐药性进行统计分析。结果连续2年该医院骨科住院患者送检病原学标本中共检出病原菌448株,其中多重耐药菌146株,占检出病原菌数的32.59%。检出多重耐药菌主要包括耐甲氧西林金黄色葡球菌(MRSA)、产β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌、多耐药铜绿假单胞菌(MDR-PA)。大肠埃希菌和肺炎克雷伯菌对部分头孢类抗菌药物耐药率超过90%,但对碳青霉烯类比较敏感;金黄色葡萄球菌对50%以上的抗菌药物耐药率均超过90%,仅对利奈唑胺、万古霉素和替考拉宁等较敏感。结论该医院骨科患者多重耐药菌感染率较高,ESBLs大肠埃希菌居首位,均严重耐药,严格管理抗菌药物应成为主要防控措施。

Objective To explore the multidrug-resistant bacteria in orthopedics patients with nosocomial infection and their resistance,so as to provide references for reasonable use of antimicrobial agents. Methods By means of the retrospec-tive survey,the species distribution and drug resistance of multidrug-resistant bacteria in 146 inpatients in a military hospi-tal department of orthopedics were analyzed statistically. Results A total of 448 strains of pathogenic bacteria causing in orthopedics patients were collected from 2 consecutive years. 146 strains of multidrug -resistant bacteria were detected, which accounted for 32. 59%. The multidrug-resistant bacteria detected mainly included methicillin-resistant Staphylo-coccus aureus （MRSA）,β-lactamases （ESBLs） -producing Escherichia coli,ESBLs-producing Klebsiella pneumoniae, and Multi-durg resistance Pseudmonas aeruginosa （MDR -PA）. The resistance rates of Escherichia coli and Klebsiella pneumoniae to some Cephalosporins were over 90%,but relatively sensitive to Carbapenems. The resistance rate of the main gram positive Staphylococcus aureusto more than 50% of antibacterials was over 90%,which was only sensitive to Linezolid, Vancomycin and Teicoplanin. Conclusion The nosocomial infection rate of multidrug-resistant bacteria in the department of orthopedics is high,ESBLs Escherichia coli ranks first. All of them were severe drug resistance,strict management of anti-microbial agents should be the main prevention and control measures.