新疆地区三级医院多重耐药菌感染及耐药性分析

Analysis of Multi-drug Resistant Infection and Drug Resistance in Tertiary Hospitals in Xinjiang Province

目的:探讨与分析近3年新疆地区三级医院多重耐药菌感染及耐药性。方法:选择2016年1月-2018年12月在新疆地区三级医院进行住院诊治的患者1100例作为研究对象,调查与检测多重耐药菌感染及耐药情况,分析导致多重耐药菌感染的危险影响因素。结果:在1100例患者中,判断为多重耐药菌感染20例,感染率为1.8%,且呈现显著升高的趋势(P<0.05)。这20例患者中检出病原菌20株,其中耐甲氧西林金黄色葡萄球菌10株、产超广谱β-内酰胺酶细菌6株、耐万古霉素肠球菌4株。甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶细菌、耐万古霉素肠球菌对呋喃妥因、亚胺培南、哌拉西林有比较高的敏感性,对庆大霉素、氨苄西林、头孢他啶、左氧氟沙星的敏感性比较低。多因素Logistic回归分析结果显示除年龄外,外置导管天数、住院时间、糖尿病、使用抗生素种类>2种、合并慢性肺部疾病、合并心血管疾病、动静脉置管、使用呼吸机为导致住院患者多重耐药菌感染的危险影响因素(P<0.05)。结论:2016年至2018年新疆地区三级医院多重耐药菌感染逐年增加,以甲氧西林金黄色葡萄球菌为主。外置导管天数、住院时间、糖尿病、使用抗生素种类>2种、合并慢性肺部疾病、合并心血管疾病、动静脉置管、使用呼吸机为导致住院患者多重耐药菌感染的危险因素,在临床治疗中,应根据患者自身的情况,有效减少接触性感染、控制感染的因素,同时根据药敏试验结果合理选择抗生素的种类和剂量,以阻止院内多重耐药菌的散播。

Objective:To explore and analyze the multi-drug resistant infection and drug resistance of tertiary hospitals in Xinjiang in recent three years.Methods:1100 patients who were hospitalized in the tertiary hospitals in Xinjiang from January 2016 to December 2018 were selected as subjects.All the patients were investigated and detected multi-drug resistant infections and drug resistance.Analyzed the dangerous effects of multi-drug resistant influence factors.Results:20 patients were diagnosed among the 1100 patients as multi-drug resistant bacteria,and the infection rate was 1.8%,showing a significant increase trend(P<0.05).20 strains of pathogens were detected in these 20 patients,including 10 strains of Methicillin-resistant Staphylococcus aureus,6 strains of Extended-spectrumβ-lactamase bacteria,and 4 strains of Vancomycin-resistant enterococci.Methicillin-resistant Staphylococcus aureus,Extended-spectrumβ-lactamase-producing bacteria,Vancomycin-resistant enterococci have high sensitivity to nitrofurantoin,imipenem,and piperacillin,and have low sensitivity to gentamicin,ampicillin,ceftazidime and levofloxacin.Multivariate logistic regression analysis showed that except age,the number of external catheter days,hospital stay,diabetes,the use of antibiotics>2,combined with chronic lung disease,combined with cardiovascular disease,arteriovenous catheterization and use of ventilator were the influencing risk factors for multidrug-resistant infection in hospitalized patients(P<0.05).Conclusion:From 2016 to 2018 years,multi-drug resistant infections in tertiary hospitals in Xinjiang region increased year by year,which are mainly methicillin-resistant Staphylococcus aureus.The number of external catheter days,hospital stay,diabetes,use of antibiotics>2,combined with chronic lung disease,cardiovascular disease,arteriovenous catheterization,use of ventilator are risk factors for multidrug-resistant infection in hospitalized patients.In clinical treatment,the factors of contact infection and infection control should be effectively reduced according to the patient's own condition.At the same time,the type and dose of antibiotics should be reasonably selected according to the results of drug susceptibility test to prevent the spread of multi-drug resistant bacteria in the hospital.