某院住院患者多重耐药菌临床分布及干预措施

Clinical distribution and intervention measures of multi-resistant bacteria with the hospital patients

目的 了解住院患者多重耐药菌感染的检出情况及临床分布特点,确定多重耐药菌监测的对象,为合理的防控方案提供依据.方法 回顾性的分析本院2014年1月至2015年12月期间检出的1159株多重耐药菌进行菌种鉴定与药敏实验,分析多重耐药菌临床分布及检测数据.结果：对检出的1159株多重耐药菌菌分析,结果 标本主要以尿液为主468株占40.38%,其次痰液标本340株占29.34%：从分布的科室情况上看,神经外科、ICU、胃肠外科、骨科为多重耐药菌主要检出的科室.其中大肠埃希菌主要分布于在神外、ICU、胃肠外、骨科.鲍曼不动杆菌主要分布于神经外科、ICU、胃肠外科.检出位于前五位多重耐药菌分别为大肠埃希菌、鲍曼不动杆菌、耐碳氢酶肠杆菌（CRE）、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌.其中大肠埃希菌695株59.97%,CRE137株占11.83%.鲍曼不动杆菌151株13.03%,铜绿假单胞菌65株5.60%,肺炎克雷伯菌52株4.49%.金黄色葡萄球菌为59株5.09%.结论 多重耐药菌感染呈现略有下降的趋势,例次感染率从2014年的22.61% 下降到2015年的10.26%,P值小于0.05有统计学意义.重点加强ESBL阳性的大肠埃西菌的防控,感染形式严峻,CRE的防控不容忽视.

Objective To provide the basis of reasonable control schemefor prevention and controling of hospital infection,by understanding multiple drug-resistant bacteria detection and clinical characteristics infection of hospitalized patients,determine the object of monitoring multi-resistant bacteria.Methods Retrospective analysis for our hospital checked out1159 strainsmulti-resist-ant bacteria during the period of between January 2014 and December 2014,and the bacteria identification and drug sensitive test are carried on.The clinical distribution and multi-resistant bacteria detection data are analyzed.Results For 1159 strains multi-resistant bacteria detection analysis,the experimental results indicate that the main specimen is urine specimen,（468 strains,40.38% ）, andthe second specimen is sputum specimen （340 strains,29.34﹪）.From the the departmentdistribution,the department of neuro-surgery,ICU,gastrointestinal surgery,orthopedics are main multi-resistant bacteria detection departments.The e.coli mainly dis-tributed in outside god,ICU,parenteral and orthopaedic.However,the acinetobacter baumannii mainly distributed in neurosurgery, ICU and gastrointestinal surgery.The top five multi-resistant bacteria of detection were the e.coli,acinetobacter baumannii,hydro-carbon enzyme resistant enterobacteriaceae （CRE）,pseudomonas aeruginosa,klebsiella pneumoniae and staphylococcus aureus.The e.Coli has 695 strains,accounting for 59.97%;CRE has 137 strains,accounting for 11.83%,acinetobacter baumannii has 151 strains,accounting for 13.03%;pseudomonas aeruginosa has 65 strains,accounted for 5.60%;Klebsiella pneumoniae has 52 strains,accounting for 4.49%;Staphylococcus aureus has 59 strains,accounting for 5.09%.Conclusion Multiple drug-resistant bacteria infection slightly decreases trends,the infection rates of case falls in from 22.61% in 2014 to 10.26% in 2015,P value is less than 0.05,which has statistical significance.The prevention and control of e.coli bacteria for ESBL positive should be strength-ened.The infection form is still grim,the prevention and control of CRE don′t ignore.