2011年儿童医院多重耐药菌目标性监测分析  

The analysis of targeted monitoring to MDRO in children's hospita in 2011

作　　者：代富力[1] 李蜀蓉[2] 

机构地区：[1]洛阳市妇女儿童医疗保健中心急诊科,471000 [2]洛阳市妇女儿童医疗保健中心控感科,471000

出　　处：《中国实用医药》2012年第27期37-39,共3页China Practical Medicine

摘　　要：目的对儿童医院多药耐药菌采取目标性监测,探讨多药耐药菌的干预措施,预防感染爆发。方法 2011年1月至2011年12月开展多药耐药菌目标性监测,实施干预,包括宣教和培训,采取接触隔离预防控制措施,每日通过到细菌室监测多药耐药菌,并到各科室督察实施。结果全年儿童医院共监测出多药耐药菌459株,前4位为耐苯唑西林的凝固酶阴性葡萄球菌(MRCNS)、产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌、耐苯唑西林的革兰阳性细菌MRSA,真菌61株;主要分布在新生儿科和儿科,分别占49.23%和42.50%,其次是外科占6.35%。其中社区感染480株,占92.31%,医院感染40株,占7.69%,没有出现感染爆发。产ESBLs革兰阴性杆菌对碳青霉烯类敏感率在100%,对氨基甙类抗生素为37.75%至95.98%,对常用的β内酰胺酶抑制复合剂敏感率为83.53%至29.72%;对其他大部分β内酰胺类抗生素几乎全部耐药。多重耐药嗜麦芽窄食单胞菌除对复方新诺明、头孢他啶敏感率在100%和55.56%外,对常用的β内酰胺酶抑制复合剂敏感率极低,对碳青霉烯类先天耐药;MRCNS和MRSA对青霉素药敏率为零,对红霉素小于10%,MRSA对呋喃妥因、万古霉素、夫西地酸钠药敏率为100%,而MRCNS仅对呋喃妥因100%敏感,MRCNS较MRSA耐药情况严重。结论对儿童医院多药耐药菌目标性监测有效,多药耐药菌耐药情况严重,抗菌药物合理应用及多药耐药菌动筛查非常重要。Objective To make objective monitoring to multidrug-resistant organism（MDRO） in children’s hospital,to study intervention measure and prevent outbreat.Methods From Jan to Dec of 2011,we had developed an objective monitoring and interventional measures to MDRO of children’s hospital,including education and training,contact isolation and precaution,monitoring and registering daily MDRO to Bacteriology Room,and superintend to every department.Results A total of 459 strains of MDRO,mainly composed of MRCNS,E.coli of ESBLs positive,klebsiella pneumonia of ESBLs positive,MRSA,and 61 strains of fungus were monitored and registered,mainly distributing in neonates department,49.23%,and Division of Pediatrics,42.50% and surgical department,6.35%,including 480 strains of community-acquired infection and 40 strains of hospital infection,we haven’t found outbreat.The agent sensitive rate of gram-negative bacteria of ESBLs positive to imipenem and Meropenem was 100%,to aminoglycosides antibiotics was 37.75%to 95.98%,to β-Lactam Antibiotics Adding enzyme inhibitor was 83.53% to 29.72% and to orther β-Lactam Antibiotics was zero.The agent sensitive rate of Stenotrophomonas maltophilia to Trimethoprim＋Sulfamethoxazole and ceftazidime was 100% and 55.56%,that to almost other anti-infective agents was zero.The agent sensitive rate of MRCNS and MRSA to penicillin was zero,to Erythromycin,lower than 10%.The agent sensitive rate of MRSA to nitrofurantoin,vancomycin and Fusidic Acid was 100%,that of MRCNS only to nitrofurantoin was 100%,.Drug resistance of MRCNS was severer than MRSA.Conclusion It is effective that targeted monitoring to MDRO and the Drug resistance of MDRO was severe,at the same time,it is important to strengthen management of antibacterials rational use and active screening to MDRO.

关 键 词：儿童医院 多药耐药菌 目标性监测 

分 类 号：R446.5[医药卫生—诊断学]