三甲医院全科病房多重耐药菌定植感染监测及相关预防干预对策研究

Monitoring of colonization of multi-drug resistant colonies in general wards of grade three A hospitals and related preventive intervention strategies

目的探讨三甲医院全科病房多重耐药菌定植感染监测情况。方法选择2015年3月-2018年11月在三甲医院全科病房住院治疗的患者58例纳入本次研究,统计住院患者多重耐药性致病菌定植感染发生率,调查多重耐药性致病菌定植感染致病菌分布及耐药性。结果全科病房患者共分离定植感染病原菌94株,包括46株(48.94%)革兰阴性菌、33株(35.11%)革兰阳性菌;革兰阴性菌主要为肺炎克雷伯菌、大肠埃希菌,革兰阳性菌为凝固酶阴性葡萄球菌。肺炎克雷伯菌、大肠埃希菌对第2代、3代头孢有耐药性,对磺胺类药物有高度耐药性,对第4代头孢存在中度耐药性;而凝固酶阴性葡萄球菌、金黄色葡萄球菌对大环内酯类药物存在高度耐药性,对青霉素存在广泛耐药性。结论三甲医院全科病房中患者以金黄色葡萄球菌、鲍曼不动杆菌及多重耐药菌较为常见,及时监测耐药菌定植感染情况,并实施针对性干预措施,有助于改善患者预后。

Objective To investigate the monitoring of the colonization of multi-drug resistant colonies in the general wards of the grade three A hospitals. Methods Fifty-eight patients hospitalized in the general wards of grade III A hospital from March2015 to November 2018 were included in this study,and the incidence of colonization infection with multidrug-resistant pathogenic bacteria was statistically analyzed,and the distribution and drug resistance of colonization infection with multidrug-resistant pathogenic bacteria were investigated. Results A total of 94 strains of colonized infection pathogens were isolated from patients in the general ward,including 46 strains( 48. 94%) Gram-negative bacteria and 33 strains( 35. 11%) Gram-positive bacteria;Gram-negative bacteria are mainly resistant to Klebsiella pneumoniae and Escherichia coli,and Gram-positive bacteria are coagulase-negative Staphylococci. Klebsiella pneumoniae and Escherichia coli are resistant to second-and third-generation cephalosporins,highly resistant to sulfa drugs,and moderately resistant to fourth-generation cephalosporins;coagulase-negative Staphylococci and Staphylococcus aureus are highly resistant to macrolides and widely resistant to penicillin.Conclusion The patients in the general wards of the grade three A hospitals are more common with Staphylococcus aureus,Acinetobacter baumannii and multi-drug resistant bacteria. Monitoring the colonization of drug-resistant bacteria in a timely manner and implementing targeted interventions can help improve the prognosis of patients.