综合医院多重耐药菌目标性监测与分析  

Monitor and analysis of multi-drug resistant organisms in general hospitals

作　　者：刘萍[1] 向书蓉 

机构地区：[1]四川省彭州市人民医院医院感染管理科,四川彭州611930

出　　处：《现代预防医学》2015年第2期362-365,371,共5页Modern Preventive Medicine

摘　　要：目的监测多重耐药菌(MDRO)流行特征及医院内分布,分析其耐药性以控制医院内感染。方法采用目标监测方法对2013年1-12月检出6种MDRO的监测情况进行分析。结果共分离出病原菌3 194株,其中MDRO 1911株,目标监测的MDRO 516株,占27.0%(516/1 911),包括产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌52.1%(214/411)和肺炎克雷伯菌16.0%(119/744)、耐甲氧西林金黄色葡萄球菌16.1%(42/261)、耐万古霉素肠球菌(0%)、耐碳青霉烯类鲍曼不动杆菌38.9%(84/216)及多耐药铜绿假单胞菌20.4%(57/279);主要分布在ICU(18.9‰)、肿瘤科(4.9‰)、儿科(4.5‰)、呼吸内科(3.6‰);MDRO医院感染占17.6%(91/516);产-ESBLs的大肠希菌和肺炎克伯菌对阿米卡星、头胞替坦及β-内酰胺酶抑制剂的复方抗生素制剂、碳青霉烯类有较高敏感性。大肠埃希菌对头胞唑啉、头胞曲松耐药;鲍曼不动杆菌对亚胺培南耐药率为25.2%;铜绿假单胞菌耐药性严重;金黄色葡萄球菌对利奈唑胺、万古霉素全部敏感。结论应加强对MDRO的监管尤其是社区的MDRO的监管,合理使用抗菌药物,控制耐药性的增加,防止MDRO医院内感染。Objective This study was to monitor the epidemiology and distribution of Multi-drug Resistant Organisms（MDRO） in hospitals, and analyze their drug resistance to control nosocomial infections. Methods Six MDRO were monitored and analyzed between January to December in 2013. Results A total of 3194 strains were detected. Among them 1911 were MDRO, and 516 strains 27.0%（516/1911） were the targeted MDRO, including ESBL-producing Escherichia coli 52.1%（214/411） and Klebsiella pneumonia 16.0%（119/744）, methicillin-resistant Staphylococcus aureus（MRSA） 16.1%（42/261）, vancomycin-resistant Enterococci（0%）, cabapenem-resistant Acinetobacter baumannii 38.9%（84/216） and multidrug resistance Pseudomonas aeruginosa 20.4%（57/279）. These bacteria distributed in ICU（18.9‰）, the departments of tumor（4.9‰）, pediatrics（4.5‰） and respiratory（3.6‰）. The infection by MDRO accounts for 17.6%（91/516） of nosocomial infections; ESBL-producing E.coli and K.pneumoniae isolates were highly sensitive to amikacin, cefotetan, carbapenem, β-lactamase inhibiting antibiotic agents. E.coli isolates showed resistance to cefazolin and ceftriaxone. Drug resistance rate of A. baumannii to imipenem was 25.2%. P. aeruginosa showed serious drug resistance. S. aureus isolates were linezolid and vancomycin. Conclusion It is necessary to strengthen the supervision of MDRO, especially for community MDRO regulation. Rational use of antimicrobial agents and strict control of drug resistance could prevent the spread of MDRO in hospitals.

关 键 词：多重耐药菌 目标性监测 医院感染 

分 类 号：R197.3[医药卫生—卫生事业管理]