北京某三级甲等医院多药耐药菌检出分析  

Analysis on distribution of multidrug-resistant organisms in a class-three hospital in Beijing

作　　者：贾莉萍[1] 王洪江 刘欣波[1] 冉素平[1] JIA Li-ping;WANG Hong-jiang;LIU Xin-bo;RAN Su-ping(306th Hospital of P.L.A.,Beijing 100101,China)

机构地区：[1]解放军第306医院感染控制科,北京100101

出　　处：《中华医院感染学杂志》2018年第16期2470-2473,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解北京市某三级甲等医院多药耐药菌(Multidrug-resistant Organism,MDRO)的构成和临床分布特点,为MDRO的防控和抗菌药物的合理应用提供科学指导。方法回顾性分析2017年1月1日-2017年12月31日医院24 943例住院患者的送检标本病原菌检出情况,观察分析MDRO的检出情况以及科室分布。结果医院临床住院患者标本中共分离出病原微生物4 343株,其中革兰阴性菌2 647株占60.9%、革兰阳性菌907株占20.9%、真菌789株占18.2%;4 343株病原微生物中共分离出MDRO 1 938株,检出率为44.6%,其中居前五位的分别是耐碳青霉稀类的铜绿假单胞菌(CR-PA)373株占19.2%、耐碳青霉稀类的鲍氏不动杆菌(CR-AB)316株占16.3%、产超广谱β-内酰胺酶的大肠埃希菌(ESBLs-E.coil)254株占13.1%、耐碳青霉稀类的肺炎克雷伯菌(CR-KP)224株占11.6%和耐甲氧西林的金黄色葡萄球菌(MRSA)169株占8.7%;重点监测的MDRO中主要分离于痰标本1 098株占56.7%,其次是尿标本204株占10.5%和拭子标本92株占4.7%;MDRO检出主要集中在干部病房、综合ICU和呼吸内科。结论医院MDRO以CR-PA、CR-AB、ESBLs-E.coil为主,主要分布于干部病房、综合ICU和呼吸内科,应提高对高危科室的监控,制定针对性措施,减少MDRO的感染和传播。OBJECTIVE To understand the composition and the clinical distribution of multidrug-resistant organisms（MDRO）in a class-three hospital in Beijing,so as to provide a scientific guidance for prevention and control of MDRO and rational use of antibiotics.METHODS MDROs isolated from 24 943 inpatient specimens from Jan.1,2017 to Dec.31,2017 and their division distribution were retrospectively analyzed.RESULTS A total of 4343 pathogenic microbial strains were successfully isolated,in which the most were gram-negative bacteria（2647 strains,accounting for 60.9%）,followed by gram-positive bacteria（907 strains,20.9%）and fungi（789 strains,18.2%）.Among the 4343 pathogenic microorganisms,there were 1938 strains of MDROs,with a detection rate of44.6%.The top five MDROs were carbapeaem-resistant Pseudomonas aeruginosa（CR-PA,373 strains,accounting for 19.2%）,carbapeaem-resistant Acinetobacter bauman（CR-AB,254 strains,13.1%）,extended-spectrum beta-lactamase-producing Escherichia coli（ESBLs-E.coil,316 strains,16.3%）,carbapeaem-resistant Klebsiella pneumoniae（CR-KP,224 strains,11.6%）and methicillin-resistant Staphylococcus aureus（MRSA,169 strains,8.7%）.MDROs requiring intensive monitoring were mainly detected from sputum（1098 strains,56.7%）,urine（204 strains,10.5%）and swabs（92 strains,4.7%）,and mainly distributed in cadre wards,general intensive care units and respiratory medicine department.CONCLUSION MDROs in this hospital were dominated by CR-PA,CR-AB and ESBLs-E.coil,and mainly distributed in cadre wards,general intensive care units、respiratory medicine department.Monitoring of MDROs in high-risk departments should be enhanced and specific measures should be developed in order to reduce the infection and transmission of MDROs.

关 键 词：多药耐药菌 医院感染 重点监测 

分 类 号：R378[医药卫生—病原生物学]