多重耐药菌感染防控的意义与发展趋势

Significance and development trend of prevention and control of Multidrug-Resistant Organism infection

多重耐药菌(MDRO)是目前我国医院感染防控中所面临的最主要的挑战之一。虽然部分MDRO逐渐减少,但对碳青霉烯等关键药物耐药的革兰阴性杆菌数量仍在上升,尤其是近年来耐碳青霉烯肺炎克雷伯菌快速增加。MDRO可以导致各种感染,其治疗困难,常导致患者死亡率增高、住院时间延长和医疗花费增多,对医疗安全和人民健康造成重大威胁,并大量消耗紧缺的医疗和社会资源。由于MDRO产生和播散的原因尚未被去除,在可预见的将来MDRO仍将持续成为主要的医疗和防控挑战。除了目前常见的革兰阴性细菌,多重耐药的结核分枝杆菌和真菌在将来有可能成为主要的公共卫生威胁。要积极应对MDRO,需要开展早期识别、实现医疗机构间联防联控、推广使用非接触式的环境/物表消毒措施、重视医院设计和重新审视抗菌药物管理。虽然困难重重,但只要提高意识、切实落实医院感染防控措施并联防联控,MDRO感染大体上可控可防。

Multidrug-Resistant Organism (MRDO) is one of the major challenges in the prevention and control of hospital infections in China. Although some MDROs are gradually decreasing, Gram-negative bacilli resistant to key antimicrobial agents such as carbapenem are still rising. In particular, carbapenem-resistant Klebsiella pneumoniae is rapidly increasing in clinical settings. MDROs can cause various infections. Difficulties in treatment often lead to increased patient mortality, prolonged hospital stays, and increased medical costs, posing a major threat to medical safety and public health, and consuming large amounts of medical and social resources. Since the cause of MDROs generation and dissemination has not been removed, MDROs will continue to be a major medical and prevention challenge in the foreseeable future. In addition to the current common Gram-negative bacteria, multi-drug resistant Mycobacterium tuberculosis and fungi such as Candida spp. have the potential to become major public health threats in the future. To tackle MDRO effectively, it is necessary to carry out early identification, joint prevention and control between medical institutions, promotion of noncontact environmental/objective disinfection measures, emphasis on hospital design and re-examination of antimicrobial management. Despite the difficulties, as long as the awareness is raised and the hospital infection prevention and control measures are implemented in parallel, the MDRO infection is generally controllable and preventable.