30家医院重症监护室多药耐药菌感染分布特征

Characteristics of distribution of multidrug-resistant organisms infections in intensive care units of 30 hospitals

目的通过对全国30家医院重症监护室多药耐药菌感染数据的调查,更加全面的了解重症监护病房多药耐药菌感染的病原体分布特点。方法选取2014年11月-2016年6月30家医院感染管理专职人员主动监测,每月上报1~2个ICU住院患者多药耐药菌感染病原菌种类、标本来源、感染部位等情况,并观察医护人员手卫生执行情况,填写监测表格。结果共上报多药耐药菌感染3 152例次,多药耐药菌株3 313株,耐碳青霉烯鲍氏不动杆菌1 572株,占47.45%;多耐药肺炎克雷伯菌476株,占14.37%;多耐药铜绿假单胞菌441株,占13.31%;MRSA共321株,占9.69%;大肠埃希菌238株,占7.18%;耐万古霉素肠球菌110株,占3.32%;其他多药耐药菌155株,占4.68%;痰、尿和血标本为最常见的送检标本,院外感染中痰标本所占比例大,而尿标本和血标本在院内感染所占比例大;医院内感染中呼吸机相关肺炎和导尿管相关感染发生率较高,院外感染中下呼吸道感染为主。结论重症监护室最常见的多药耐药菌为耐碳青霉烯鲍氏不动杆菌、多耐药肺炎克雷伯菌、多耐药铜绿假单胞菌;在医院内感染中呼吸机相关肺炎和导尿管相关感染发生率较高,侵入性操作仍然是多药耐药菌感染的重点环节。

OBJECTIVE To investigate the data of multidrug-resistant organisms（MDROs）infections in intensive care units（ICUs）of 30 hospitals in China so as to fully understand the characteristics of distribution of pathogens causing MDROs infections in the ICUs.METHODS Active monitoring was conducted by full-time personnel of nosocomial infection management from Nov 2014 to Jun 2016;the species of pathogens causing the MDROs infections,specimens sources,and infection sites of hospitalized patients of 1.2ICUs were reported monthly,the implementation rate of hand hygiene of health care workers was observed,and the monitoring sheets were filled out.RESULTS Totally 3 152case-times of MDROs infections were reported.Of 3 313 strains of MDROs isolated,1572（47.45%）were carbapenem-resistant Acinetobacter baumannii,476（14.37%）were multidrug-resistant Klebsiella pneumoniae,441（13.31%）were multidrug-resistant Pseudomonas aeruginosa,321（9.69%）were MRSA,238（7.18%）were Escherichia coli,110（3.32%）were vancomycin-resistant Enterococcus,and 155（4.68%）were other MDROs.The sputum,urine,and blood specimens were the most common submitted specimens;the sputum specimens occupied large proportion among the patients with community-acquired infections,while the urine and blood specimens occupied large proportions among the patients with hospital-acquired infections.The incidence rates of ventilator-associated pneumonia and catheter-related infections were relatively high among the patients with hospital-acquired infection;the patients with lower respiratory tract infection were dominant among the patients with community-acquired infections.CONCLUSIONThe carbapenem-resistant A.baumannii,multidrug-resistant K.pneumoniae,and multidrug-resistant P.aeruginosaare the most common MDROs in the ICUs.The incidence rate of ventilator-associated pneumonia and catheter-related infection are relatively high among the patients with hospital-acquired infections,and the invasive operation remains the key link to lead to the MDROs infection.