2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析

Distribution and drug resistance of gram-negative multidrug-resistant organisms isolated from 2013 to 2015 and analysis of risk factors

目的了解医院革兰阴性多药耐药菌感染的分布特点、耐药状况及危险因素,为医院感染预防控制提供依据。方法对医院2013年1月-2015年12月住院患者的各类标本进行细菌检测和耐药性分析,回顾性分析228例革兰阴性杆菌感染患者的临床资料,分为多药耐药菌组116例与非多药耐药菌组112例,进行危险因素分析。结果主要细菌依次为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌;标本来源以痰液、尿液、分泌物为主,科室分布以ICU、泌尿外科、呼吸内科检出最多;大肠埃希菌对含酶抑制剂β内酰胺类、碳青霉烯类、阿米卡星、头孢西丁耐药率较低(<20%),鲍曼不动杆菌对阿米卡星、左氧氟沙星之外的抗菌药物均呈高度耐药(>90%);多因素Logistic回归分析提示有创机械通气为革兰阴性多药耐药菌感染的独立危险因素。结论革兰阴性多药耐药菌耐药形势严峻,应加强管理,合理使用抗菌药物,针对多种危险因素采取控制措施,从而提高诊疗质量,改善患者预后。

OBJECTIVE To understand the distribution and drug resistance of gram-negative multidrug-resistant organisms （MDROs） causing infections and analyze the risk factors so as to provide guidance for prevention and con- trol of nosocomiai infections. METHODS The specimens were obtained from the patients who were hospitalized from Jan 2013 to Dec 2015, the bacteria were detected, the drug resistance was analyzed. The clinical data of 228 patients with gram-negative bacilli infections were retrospectively analyzed, the enrolled patients were divided into the MDROs group with 116 cases and the non-MDROs group, and the risk factors were analyzed. RESULTS The major species of bacteria isolated were in turn as the following： Escherichia coli, Acinetobacter baumannii , Pseudomonas aeruginosa, urine, and secretions were the major specimens sources. The majority of the strains were isolated from ICU, urology department, and respiratory medicine department. The drug resistance rates of the E. coli strains to ~]-lactams containing enzyme inhibitors, carbapenems, amikacin, and cefoxitin were low （less than 20%）. The A. baumannii strains were highly resistant to all of the antibiotics except for amikacin and levo- floxacin （more than 90M）. Multivariate logistic regression analysis indicated that the invasive mechanical ventila- tion was the independent risk factor for the gram-negative MDROs infections. CONCLUSION The situation of drug resistance of the MDROs is severe. It is necessary to strengthen the management, reasonably use antibiotics, and take control measures according to the risk factors so as to raise the quality of diagnosis and treatment and improve the prognosis.