2019--2021年某三甲医院多重耐药菌检出情况与对策

Detection and Countermeasures of Multi-Drug Resistant Bacteria in a Three-A Hospital from 2019 to 2021

目的了解某三甲医院2019—2021年多重耐药菌检出、分布、隔离医嘱下达情况,探索下一阶段防控措施。方法调查2019年1月至2021年12月住院患者多重耐药菌检出率、变化趋势、科室分布、隔离医嘱下达率。结果2019—2021年共检出多重耐药菌1861株,检出率分别为31.94%、30.19%、26.374%,在2019、2020、2021年呈逐年下降趋势。大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌检出率在2019、2020、2021年呈上升趋势,分别是17.21%~52.42%、58.63%~71.02%和29.03%~30.04%;金黄色葡萄球菌、铜绿假单胞菌检出率在2019、2020、2021年呈下降趋势,依次为23.02%~36.29%、25.31%~47.73%。分布集中在呼吸科20.63%、胸部肿瘤科15.42%、RICU 12.84%、ICU 12.63%、泌尿外科7.58%。隔离医嘱下达率只有58.03%,其中儿科最低(15.79%),骨科为31.25%,泌尿外科为34.04%;2021年较2019年有较大幅度提高(χ2=8.499,P=0.004);较2020年略有上升,但差异无统计学意义(χ2=0.329,P=0.566)。结论多重耐药菌检出率近三年呈持续下降趋势,表明防控措施取得成效;但大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌检出率呈波动上升趋势,隔离医嘱下达率较低,对防控提出新要求。

Objective To understand the situation of multi-drug-resistant bacteria detection,distribution and isolation in a three-A hospital from 2019 to 2021,and to explore the next stage of prevention and control measures.Methods To investigate the rate of multidrug-resistant bacteria detection,changing trend,department distribution and isolation order issuing rate of inpatients from January 2019 to December 2021.Results A total of 1861 strains of multi-drug-resistant bacteria were detected in 2019 and 2021,with detection rates of 31.94%,30.19%,and 26.374%,respectively,showing a decreasing trend in 2019,2020,and 2021.The detection rates of Escherichia coli,Acinetobacter baumannii,and Klebsiella pneumoniae showed an increasing trend in 2019,2020,and 2021,which were 17.21%to 52.42%,58.63%to 71.02%,and 29.03%to 30.04%,respectively;the detection rates of Staphylococcus aureus and Pseudomonas aeruginosa showed a decreasing trend in 2019,2020,and 2021,which were,respectively 23.02%-36.29%and 25.31%-47.73%.The distribution was concentrated in the respiratory department 20.63%,thoracic oncology department 15.42%,RICU 12.84%,ICU 12.63%,and urology department 7.58%.The rate of isolation orders was only 58.03%,with the lowest in pediatrics(15.79%),31.25%in orthopedics,and 34.04%in urology;there was a substantial increase in 2021 compared with 2019(χ2=8.499,P=0.004);and there was a slight increase compared with 2020,but the difference was not statistically significant(χ2=0.329,P=0.566).Conclusions The detection rate of multidrug-resistant bacteria showed a continuous decline in the past three years,indicating that the prevention and control measures were effective.However,the detection rate of Escherichia coli,Klebsiella pneumoniae and Acinetobacter baumannii fluctuated and increased,and the issuing rate of isolation doctor's order was low,which put forward new requirements for prevention and control.