感染科多重耐药菌株感染分布及耐药情况的调查分析

Investigation and analysis of infection distribution and drug resistance of multi-drug resistant strains in the infectious diseases department

目的对感染科感染的多重耐药菌株分布情况以及耐药情况进行调查,为临床护理早期监测提供数据支持。方法选取我院感染科2017年1月至2019年1月入住的375例感染患者作为研究对象,将多重耐药菌株感染100例患者纳入观察组,未多重耐药菌感染275例患者纳入对照组,采集患者性别、年龄、感染部位、APEACHEⅡ评分、格拉斯哥昏迷评分(GCS)、菌株分布、病原菌来源分布、耐药情况,构建合理的护理措施防控多重耐药菌感染风险。结果2017年1月至2019年1月共进行4次主动筛查,分离出6种致病菌共1786株,其中100例患者出现多重耐药菌感染,多重耐药菌株724株,本院多重耐药菌感染率为26.67%(100/375),多重耐药菌定植率为40.54%(724/1786);多重耐药菌感染患者的病原菌来源主要为痰液及尿液,分别占比为43.93%,24.03%,其次为腹水占18.23%,血液中定植多重耐药菌最少占13.81%;药敏实验结果显示,多重耐药菌株主要对磷霉素、妥布霉素、头孢吡肟、头孢他啶、庆大霉素、复方新诺明、氨曲南、氨苄西林/舒巴坦、左旋氧氟沙星等主流抗生素存在耐药情况,耐药率为94.73%~100.00%;经ROC曲线测算,年龄最佳截断值>63岁、APACHEⅡ评分最佳截断值>26分属于多重耐药菌株感染的危险因素(P<0.05),GCS评分最佳截断值≤6分属于多重耐药菌株感染的保护因素(P<0.05)。结论感染科多重耐药菌株感染病原菌来源主要以呼吸道感染的痰液样本及尿路感染的尿液为主,对多重常用抗生素均存在耐药情况,采用早期监测APACHEⅡ评分、GCS评分及合理护理措施,能够有效降低多重耐药菌感染风险。

Objective To investigate the distribution and drug resistance of multi-drug resistant strains in the infectious diseases department,and provide data support for early monitoring of clinical care.Methods We selected 375 cases of infected patients admitted from January 2017 to January 2019 in the Department of Infection of our hospital as the study objects,of which 100 cases of infected patients with multi-drug resistant strains were included in an observation group,and 275 cases of infected patients without multi-drug resistant infections were included in a control group.Gender,age,collected the infection site,APEACHE II score,Glasgow coma scale(GCS)score,strain distribution,pathogen source distribution,and drug resistance,and constructed reasonable nursing measures to prevent and control the risk of infection with multi-drug resistant strains.Results From January 2017 to January 2019,a total of 4 active screenings were carried out,and a total of 1786 strains of 6 kinds of pathogenic bacteria were isolated.Among them,100 cases of patients developed multi-drug resistant strains infections,and 724 strains of multi-drug resistant strains.The infection rate of multi-drug resistant bacteria was 26.67%(100/375),and the colonization rate of multi-drug resistant strains was 40.54%(724/1786),and the source of pathogenic bacteria in patients with multi-drug resistant bacteria was mainly sputum and urine,accounting for 43.93%%and 24.03%,respectively,followed by ascites accounted for 18.23%,and at least 13.81%of multi-drug resistant bacteria were colonized in the blood.The results of drug susceptibility experiments showed that the multi-drug resistant strains were mainly for fosfomycin,tobramycin,cefepime,ceftazidime,gentamicin,compound new Nuomin,aztreonam,ampicillin/sulbactam,levofloxacin and other mainstream antibiotics had drug resistance,the drug resistance rate was 94.73%-100.00%.According to the measurement of ROC curve,the best cut-off value of years old was>63 years old,the best cut-off value of APACHE II score>26 points was the risk factor of multi-drug resistant strains infection(P<0.05),and the best cut-off value of GCS score≤6 points was a protective factor of multi-drug resistant strains infection(P<0.05).Conclusion The source of pathogens of multi-drug resistant strains in the infectious diseases department was mainly sputum samples from respiratory tract infections and urine from urinary tract infections.There were resistance to multiple commonly used antibiotics.Early monitoring of APACHE II score,GCS score and reasonable care should be adopted,which can effectively reduce the risk of infection with multi-drug resistant strains.