多重耐药菌的分布特点及院感控制

Distribution Features and Hospital Infection Control of Multiple-drug Resistant Germs

目的探析临床常见多重耐药菌(MDROs)分布特点,并制定出有效积极的措施控制院感。方法将2014年10月—2017年10月该院接收的住院患者98 682例感染MDR-AB(多重耐药鲍曼不动杆菌)、MRSA(耐甲氧西林金黄色葡萄球菌)、CRE(耐碳氢青霉烯类肠杆菌科细菌)以及MDR-PA(多重耐药铜绿假单胞菌)的临床资料展开回顾性分析,对其来源进行分析,同时探讨科室分布特征。结果 MDROs感染总计904例,其中医院感染444例(49.1%),社区感染460例(50.9%),这两者MDROs感染率相当,差异无统计学意义(χ~2=0.566 4,P=0.4517);分布病区较多,最多见的为综合ICU(29.7%)、整形烧伤科(11.5%)以及皮肤科(6.4%);MDROs检出率分别为MRSA 418株,占比为46.2%;MDR-AB 318株,占比为37.2%;MDR-PA 112株,占比为12.4%;CRE 56株,占比为6.2%;未检出VRE(耐万古霉素肠球菌)。结论医院与社区内均分布着MDROs,其中科室分布比较广泛,存在分类聚集情况,重点加强对易感人群和高危科室的监控,有利于遏制MDROs在医院内的感染及传播。

Objective To study the distribution features of multiple-drug resistant germs in clinic and make the effective and positive measures to control the hospital infection. Methods The clinical data of 98 682 cases of inpatients infected with MDR-AB, MRSA, CRE and MDR-PA from October 2014 to October 2017 were reviewed, and the sources were analyzed, at the same time, the distribution features were studied. Results There were 904 cases with MDROs infection, including 444 cases with hospital infection 49.1%, 460 cases with community infection 50.9%, and the MDROs infection rate of the two was similar, without statistical significance（χ~2=0.566 4, P=0.451 7）;and the distribution ward was more, and the comprehensive ICU（29.7%）, the department of burn and plastic surgery（11.5%） and department of dermatology（6.4%）, and the MDROs test rate included 418 strains of MRSA, accounting for 46.2%, 318 strains of MDR-AB, accounting for 37.2%, and 112 strains of MDR-PA, accounting for 12.4%, and 56 strains of CRE,accounting for 6.2%, and the VRE was not tested. Conclusion The MOROs is distributed in the hospital and community, and the distribution in the department is wide, with taxonomic aggregation, and we should pay more attention to enhancing the monitoring of the susceptible population and high-risk department, which is conducive to preventing the infection and spread of MOROs in the hospital.