重症医学科住院患者多药耐药菌感染的临床分析及耐药性监测  

Clinical analysis of multi-drug resistant organism and monitoring of antimicrobial resistance from hospitalized patients of ICU

作　　者：崔从先[1] 李奇峰[2] 童惠林 吴坤[3] 吴瑗[3] 

机构地区：[1]青岛大学附属医院物资供应部,山东青岛266003 [2]青岛大学附属医院感染管理部,山东青岛266003 [3]青岛大学附属医院眼科,山东青岛266003

出　　处：《中华医院感染学杂志》2017年第11期2430-2433,共4页Chinese Journal of Nosocomiology

摘　　要：目的对重症医学科(ICU)住院患者多药耐药菌感染状况进行调查分析,了解医院ICU感染谱以及多药耐药菌(MDRO)的流行趋势,为预防和控制多药耐药菌在医院内传播,降低医院感染率提供依据。方法本研究采取回顾性研究方法,统计分析2015年12月-2016年11月,在医院ICU住院患者632例,1 296份送检标本的培养结果进行临床分析。结果调查合格标本1 296份,共分离出病原菌503株,分离率为38.81%;其中分离出MDRO 181株,占35.98%;检出的MDRO类型主要包括耐碳青霉烯类鲍氏不动杆菌(CRABA,20.44%)、产ESBLs大肠埃希菌(19.89%)、产ESBLs肺炎克雷伯菌(16.57%)、耐甲氧西林金黄色葡萄球菌(MASA,6.63%)、耐碳青霉烯类铜绿假单胞菌(CRPAE,4.97%)等;MDRO检出主要来源于痰液、血液、尿液、脓液、渗出液、胆汁等标本,分布于呼吸道(56.35%),菌血症(12.71%);泌尿道(7.18%),器官腔隙(6.63%),手术部位切口(5.52%);绝大部分MDRO能耐受多种常用抗菌药物。结论 MDRO已成为医院感染的主要病原菌,合理应用抗菌药物、严格落实感控措施对预防和控制MDRO的产生和传播起到重要作用。OBJECTIVE To investigate the infection status of multi-drug resistant organism （MDRO） of hospitalized patients of Intensive Care Unit （ICU）,so as to provide the basis for prevention and control of nosocomial infections caused by MDRO and reducing the infection rate.METHODS A total of 632 cases of hospitalized patients of ICU from Dec.2015 to Nov.2016 were statistically analyzed using retrospective method,and the cultural results of 1296 specimens were analyzed.RESULTS Totally 503 pathogens were isolated from 1296 specimens,with the isolation rate of 38.81%,among which 181 （35.98%） strains were MDRO,and the main MDRO were carbapenemresistant Acinetobacter baumannii （CRABA,20.44 %）,E.coli-ESBLs（19.89 %）,Klebsiella pneumoniae ESBLs （16.57%）,MASA（6.63%）,and carbapenem-resistant Pseudomonas aeruginosa （CRPAE,4.79%）.Most of MDRO were from sputum,blood,urine,pus,exudates and bile,which mainly distributed in respiratory tract （56.35%）,bacteremia （12.71%）,urinary tract（7.18%）,organ space（6.63%）,and incision of surgical site （5.52%）.The majority of MDRO were resistant to a variety of commonly used antibacterial drugs.CONCLUSION MDRO have become the main pathogens of nosocomial infections.Reasonable application of antibacterial drugs and strict implementation of the control measures play an important role to prevent and control the generation and spread of MDRO.

关 键 词：多药耐药菌 临床分析 耐药性监测 

分 类 号：R378[医药卫生—病原生物学]