基于细菌耐药监测系统的多重耐药菌分析与对策  

Analysis and countermeasures of multidrug-resistant bacteria based on bacterial resistance surveillance system

作　　者：邹胜男 袁丽[1] 吕小艳[2] 孙昕 陈贵梅[4] 王巧玲[1] ZOU Sheng-nan(Department of hospital infection management,the second affiliated hospital of Bengbu Medical College,Bengbu, Anhui, 233040, China)

机构地区：[1]蚌埠医学院第二附属医院医院感染管理科,安徽蚌埠233040 [2]蚌埠医学院第二附属医院微生物室,安徽蚌埠233040 [3]蚌埠医学院第二附属医院党(院)办,安徽蚌埠233040 [4]安徽医科大学卫生管理学院,安徽合肥230032

出　　处：《齐齐哈尔医学院学报》2019年第13期1656-1658,共3页Journal of Qiqihar Medical University

基　　金：2018年度蚌埠医学院人文社科基金面上项目(BYKY18175sk)

摘　　要：目的明晰医院多重耐药菌的分布情况和变化趋势,规范和改进细菌耐药监测工作,进一步优化医院感染管理流程。方法经Lis系统提取某医院微生物实验室提供的2015年1月—2018年8月该医院细菌耐药监测结果,结合医院感染管理部门目标性监测情况,收集多重耐药菌感染相关数据,采用Excel 2010进行数据录入,用SPSS 16.0统计软件进行分析。结果2015年1月—2018年8月共监测住院病例80 665例,送检标本20625例次,检出病原菌4 195株,其中多重耐药菌1 191株,多重耐药菌检出率28.4%;1191株多重耐药菌中男性748人次,女性443人次,平均年龄61.8岁;标本分布情况依次为痰60.2%、尿液15.8%、血液9.5%,分泌物3.4%;肠杆菌科细菌占所有分离菌株的53%,不发酵糖革兰阴性菌占所有分离菌株的29.3%,革兰阳性菌占所有分离菌株的10.5%,不同细菌在不同年度的耐药率差异具有统计学意义(P<0.05);2015—2018年检出多重耐药菌人次排名前五的科室分别为重症医学科(34.7%)、呼吸内科(9.7%)、泌尿外科(9.4%)、神经外科(9.2%)和急诊消化病区(7.3%)。结论细菌耐药形势依然严峻,可通过强化细菌耐药监测多学科合作管理模式,建立基于信息化建设的医院感染环管理流程,进一步加强医院感染预防控制管理工作。Objective To clarify the distribution and trend of multi-drug resistant bacteria in hospital,improve the monitoring of bacterial resistance,and optimize the process of hospital infection management.Methods The results of bacterial drug resistance surveillance in a hospital from January 1 st,2015 to August 31 th,2018 were extracted from Lis system.Combined with the target surveillance situation of nosocomial infection management department,data related to multi-drug resistant bacterial infection were collected and entered into Excel 2010 and analyzed by SPSS 16.0 statistical software.Results There were 80 665 hospitalized cases were monitored in total and 20 625 specimens were sent for examination from January 1 st,2015 to August 31th,2018. 4195 strains of pathogenic bacteria were isolated,including 1191 strains of multi-drug resistant bacteria. The detection rate of multi-drug resistant bacteria was 28.4%.748 of 1191 strains of multi-drug resistant bacteria were male and 443 were female,with an average age of 61. 8 years. Enterobacteriaceae accounted for 53% of all isolates,non-fermenting Gram-negative bacteria accounted for 29.3% of all isolates,and Gram-positive bacteria accounted for 10.5% of all isolates.The drug resistance rates of different bacteria in different years were statistically significant.The top five departments of multidrug resistant bacteria were intensive care unit( 34. 7%),respiratory unit( 9.7%),urinary surgery unit( 9.4%),neurosurgery unit( 9.2%) and Emergency digestion unit( 7.3%). Conclusions The situation of bacterial resistance is still grim.The management of nosocomial infection prevention and control could be further strengthened by strengthening the multi-disciplinary cooperative management mode of bacterial resistance monitoring and establishing the closed-loop management process of nosocomial infection based on information construction.

关 键 词：细菌 多重耐药 对策 

分 类 号：R184.6[医药卫生—流行病学]