多药耐药菌目标性监测与感染防控对策

Targeted surveillance and infection control of muitidrug-resistant organisms

目的探讨医院多药耐药菌(MDROs)流行分布特点与感染防控策略。方法对2015年1月-12月住院患者各类标本采用微生物分析仪进行细菌鉴定和药敏试验,采用WHONET 5.5软件处理药敏数据;开展MDROs感染目标性监测,对MDROs监测结果进行统计分析,采取干预措施控制多药耐药菌医院感染。结果医院检出MDROs 637株,以产ESBLs-ECO为主,共344株占54.0%;分离的MDROs主要来源于痰液,共252株占39.6%;MRSA对红霉素、青霉素G、苯唑西林耐药率较高,均为100.0%;产ESBLs-大肠埃希菌、产ESBLs-肺炎克雷伯菌对氨苄西林耐药率较高,均>95.0%,CR-鲍氏不动杆菌对氨曲南、头孢吡肟、头孢他啶、环丙沙星、庆大霉素、亚胺培南、磺胺甲噁唑/甲氧苄啶耐药率较高,均>90.0%。结论医院应加强多药耐药菌的目标性监测,做好消毒隔离工作,正确合理使用抗菌药物,防控多药耐药菌医院感染。

OBJECTIVE To investigate the distribution characteristics of multidrug-resistant bacteria （MDROs） in hospital and the strategy of prevention and control of infection.METHODS Identification of bacteria and antibiotic sensitivity test were performed on various specimens of hospitalized patients from Jan.2015 to Dec.2015 by automated microbe analyzer.Drug sensitive data were processed by WHONET5.5 software.Objective surveillance of MDROs infection was carried out.The data were statistically analyzed.Effective control measures were adopted to control the nosocomial infections of MDROs.RESULTS Totally 673 strains of MDROs were detected, which were mainly 344 strains of ESBLs-producing ECO, accounting for 54.0%.The isolated MDROs mainly came from sputum, which was a total of 252 strains, accounting for 39.6%.The resistant rates of MRSA to erythromycin, penicillin G and oxacillin were high, which were all 100.0%.ESBLs-producing Escherichia coli and ESBLs-producing Klebsiella pneumoniae had high resistant rates to ampicillin, which were both higher than 95.0%.Carbapenem resistant Acinetobacter baumannii had high resistant rates to aztreonam, cefepime, ceftazidime, imipenem, ciprofloxacin, gentamicin, and trimethoprim/sulfamethoxazole, which were all higher than 90%.CONCLUSION It is necessary to strengthen the targeted surveillance of MDROs in the hospital, meanwhile complete the work of disinfection and isolation, and reasonably use antibiotics, so as to prevent and control the infections of MDROs.