儿童下呼吸道感染多重耐药菌监测与集束化干预

The monitoring of multiply drug resistant organism and bundled intervention of child with lower respiratory-tract infections

目的了解本院18岁以下儿童下呼吸道感染多重耐药菌(MDROs)感染分布及耐药情况分析,为制定集束干预策略提供依据。方法采用回顾性分析方法,对本院连续4年入住ICU、儿内科、NICU、新生儿科的18岁以下患儿下呼吸道痰液标本分离培养鉴定和药敏试验结果进行分析。结果从送检的11563份痰液标本中分离出病原菌4057株,其中MDROs 377株,检出率9.28%,检出前四位依次为甲氧西林金黄色葡萄球菌(MRSA) 113株、大肠埃希菌(ESBLs+) 91株、肺炎克雷伯杆菌(ESBLs+) 41株、耐亚胺培南的铜绿假单胞菌42株; MDROs感染发生率依次为ICU、儿内科、NICU、新生儿科。结论儿童MDROs感染来源以社区为主,主要菌株为MRSA,感染率最高为ICU;加强特殊区域儿童下呼吸道感染多重耐药菌的监测,制定相关MDROs感染的控制措施及集束干预策略,是防止院内感染事件的关键。

Objective To explore the infection distribution and drug resistance of multiply drug resistant organism in children under 18 with lower respiratory-tract infection,providing evidences for making bundled intervention strategies. Methods A retrospective investigation was implemented,the sputum sample was isolated from lower respiratory tract of children under 18 who were admitted into ICU,pediatric internal medicine department,NICU,neonatology department in the last 4 years. The results of culture and drug sensitive test were analyzed. Results 377 strains of MDROs were found in the 4057 pathogenic bacteria separated from 11563 sputum samples,the detection rate was 9. 28%. The four top pathogenic bacteria are methicillin staphylococcus aureus( MRSA,n = 113),escherichia coli( ESBLs +,n = 91),klebsiella pneumoniae( ESBLs +,n = 41) and resistance to imipenem pseudomonas aeruginosa( n = 42). The top four MDROs infections rate of hospital departments are ICU,pediatric internal medicine department,NICU,neonatology department. Conclusions The MDROs infections mainly come from the community,the main bacteria strain is MRSA,and the highest infections rate is in the ICU. Strengthen the monitoring of MDROs in special zone in the hospital and making control and bundled intervention strategy for infection management is the key to prevent nosocomial infection.