某三级妇幼保健院多重耐药菌分布、耐药性及其感染控制  

Distribution,Drug Resistance and Infection Control of Multidrug-Resistant Organisms in a Tertiary Maternity and Child Health Care Hospital in 2019-2021

作　　者：张胜男[1] 吴岷岷 徐文君[1] 王洁[2] 杨力[1] 钟天鹰[3] ZHANG Shengnan;WU Minmin;XU Wenjun;WANG Jie;YANG Li;ZHONG Tianying(Office of Infection Management,Maternity Hospital Affiliated to Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing,Jiangsu,210004;Office of Infection Management,Maternity Hospital Affiliated to Nanjing Medical University,Human Resource Department,Nanjing,Jiangsu,210004;Office of Infection Management,Maternity Hospital Affiliated to Nanjing Medical University,President’s Office,Nanjing,Jiangsu,210004)

机构地区：[1]南京医科大学附属妇产医院、南京市妇幼保健院感染管理办公室,江苏南京210004 [2]南京医科大学附属妇产医院、南京市妇幼保健院人事处,江苏南京210004 [3]南京医科大学附属妇产医院、南京市妇幼保健院院长办公室,江苏南京210004

出　　处：《江苏卫生事业管理》2022年第11期1474-1479,共6页Jiangsu Health System Management

摘　　要：目的:分析多重耐药菌的分布和耐药情况,为临床合理使用抗菌药物和感染控制提供依据。方法:采用回顾性分析方法,收集2019年1月-2021年12月某三级妇幼保健院住院患者多重耐药菌等资料,了解多重耐药菌临床分离株的分布情况并进行耐药性分析,鉴别诊断医院感染和社区感染。结果:临床分离185株多重耐药菌,分离出119株MRSA、7株VRE、41株CRE、17株CRPA和1株CRAB,其中10例MRSA、3例CRE和11例CRPA医院感染。药敏结果显示:MRSA对万古霉素、替考拉宁、替加环素和利奈唑胺的耐药率均为0,VRE对利奈唑胺、呋喃妥因和氨苄西林耐药率为0,CRE对美罗培南耐药率为46.34%、亚胺培南51.22%,CRPA对美罗培南和亚胺培南的耐药率均为64.7%。医院感染的MRSA主要使用万古霉素和(或)哌拉西林他唑巴坦治疗,医院感染的CRE主要使用美罗培南(敏感)治疗,医院感染的CRPA主要使用(或联合)美罗培南治疗或依据药敏结果选择敏感的抗菌药物治疗。结论:该院的多重耐药菌耐药情况与全国耐药情况基本一致,耐药形势仍严峻,需要同时开展抗菌药物临床应用管理和感染控制,兼顾通用和个性化策略,综合防控多重耐药菌的传播和医院交叉感染。Objective:The distribution and resistance of multidrug-resistant organisms were analyzed to provide basis for rational use of antibiotics and infection control in clinical.Methods:By retrospective analysis,data of multiple drug-resistant organisms from inpatients in a certaintertiary maternity and child health hospital from January 2019 to December 2021 were collected to understand the distribution of multidrug-resistant organisms clinical isolates,conduct drug resistance analysis,and differentiate nosocomial infec⁃tion from community infection.Results:185 multidrug-resistant organisms were isolated clinically,including 119 MRSA,7 VRE,41 CRE,17 CRPA and 1 CRAB.Among them,10 MRSA,3 CRE and 11 CRPA cause nosocomial infections.Drug sensitivity results showed that:The resistance rates of MRSA to vancomycin,teicoplanin,tigecycline and linezolid were 0,VRE to linezolid,furantoin and ampicillin were 0,CRE to meropenem was 46.34%,imipenem was 51.22%,CRPA to meropenem and imipenem were 64.7%.Noso⁃comial MRSA is mainly treated with vancomycin and/or piperacillin tazobactam,nosocomial CRE is mainly treated with meropenem(sensitive),nosocomial CRPA is treated with(or in combination with)meropenem or with sensitive antimicrobial agents.Conclusion:The situation of multidrug-resistant organisms resistance in the hospital is basically consistent with that in the whole country,and the situation of drug resistance is still severe.Therefore,it is necessary to carry out clinical application management of antibiotics and in⁃fection prevention and control simultaneously,and to comprehensively prevent and control the spread of multidrug-resistant organisms and nosocomial cross infection by taking into account general and personalized strategies.

关 键 词：细菌耐药 多重耐药菌 感染控制 院内感染 

分 类 号：R197.39[医药卫生—卫生事业管理]