院内多重耐药菌分布特点及规范化护理管理对院内感染控制效果研究  

A study on the distribution characteristics of multidrug-resistant bacteria in our hospital from 2017 to 2023 and the effect of standardized nursing management on hospital infection control

作　　者：黄晓娇 陈晟 HUANG Xiaojiao;CHEN Sheng(Gezhouba Central Hospital of Sinopharm,Third Clinical Medical College of the Three Gorges University,Yichang 443002,Hubei,China)

机构地区：[1]三峡大学第三临床医学院国药葛洲坝中心医院,湖北宜昌443000

出　　处：《中国病原生物学杂志》2024年第5期599-603,共5页Journal of Pathogen Biology

摘　　要：目的探讨2017-2023年本院院内多重耐药菌分布特点及规范化护理管理对院内感染控制效果。方法选取2017-2023年本院各科室送检的病原生物学标本,对耐碳青霉烯类肠杆菌科细菌(CRE)(包括大肠埃希菌、肺炎克雷伯菌)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)(包括屎肠球菌、粪肠球菌)、耐碳青霉烯类鲍曼不动杆菌(CRABA)、耐碳青霉烯类铜绿假单胞菌(CRPAE)进行目标性监测。本院自2021年1月1日起施行规范化护理管理,对比管理前后多重耐药菌的检出情况。结果2017-2023年,共分离病原菌16401株,检出多重耐药株974株,检出率5.94%(974/16401)。2017-2023年各年度检出率分别为8.27%、7.04%、7.53%、8.09%、5.21%、4.63%和3.33%。974株多重耐药菌中,MRSA共341株,CREC共40株,CRKP共36株,CRAB共414株,CRPAE共143株,未检出VRE菌株。974株多重耐药菌中,63.76%来源于痰液标本,16.02%来源于伤口分泌物标本,4.41%来源于导管尖端标本,4.21%来源于血液标本,2.16%来源于脓液标本,1.33%来源于尿液标本,1.33%来源于肺泡灌洗液,0.31%来源于引流液,6.47%来源于其他标本。CRAB、MRSA、CRPAE主要来源于痰液标本,其次为伤口分泌物,CREC、CRKP主要来源于痰液标本,其次为肺泡灌洗液。CRAB菌株对头孢呋辛、亚胺培南、美罗培南全部耐药,对头孢哌酮、头孢他啶、环丙沙星、左氧氟沙星、妥布霉素、阿米卡星、庆大霉素、复方磺胺甲恶唑的耐药率较高,对米诺环素、替加环素、多粘菌素B表现为较高的敏感性。MRSA菌株对青霉素G、氨苄西林、红霉素全部耐药,对克拉霉素、环丙沙星、庆大霉素、妥布霉素、四环素的耐药率较高,对替考拉宁、万古霉素、利奈唑胺、呋喃妥因均敏感,未产生对其耐药株。管理前多重耐药菌的检出率为7.74%(694/8968),管理后检出率为4.39%(280/6374),MRSA、CREC、CRAB、CRPAE的检出率由管理前的19.38%、0.Objective To explore the distribution characteristics of multidrug-resistant bacteria in our hospital from 2017 to 2023 and the effect of standardized nursing management on hospital infection control.Methods The pathogenic biological specimens submitted by various departments of our hospital were selected from January 2017 to December 2023,The carbapenem resistant Enterobacteriaceae(CRE)(including Escherichia coli and Klebsiella pneumoniae),methicillin-resistant Staphylococcus aureus(MRSA),vancomycin resistant Enterococcus(VRE)(including Enterococcus faecium and Enterococcus faecalis),carbapenem resistant Acinetobacter baumannii(CRABA)were targeted monitored.Our hospital has implemented standardized nursing management since January 1,2021,and the detection of multidrug-resistant bacteria before and after management were compared.Results From 2017 to 2023,a total of 16401 pathogenic bacteria were isolated,and 974 multidrug-resistant strains were detected,with a detection rate of 5.94%(974/16401).The detection rate was 8.27%in 2017,7.04%in 2018,7.53%in 2019,8.09%in 2020,5.21%in 2021,4.63%in 2022,and 3.33%in 2023.Among the 974 strains of multidrug-resistant bacteria,341 strains were MRSA,40 strains were CREC,36 strains were CRKP,414 strains were CRAB,and 143 strains were CRPAE.No VRE strains were detected.Among the 974 strains of multidrug-resistant bacteria,63.76%came from sputum specimens,16.02%from wound secretion specimens,4.41%from catheter tip specimens,4.21%from blood specimens,2.16%from pus specimens,1.33%from urine specimens,1.33%from alveolar lavage fluid,0.31%from drainage fluid,and 6.47%from other specimens.CRAB,MRSA,and CRPAE mainly came from sputum specimens,followed by wound secretions.CREC and CRKP mainly came from sputum specimens,followed by alveolar lavage fluid.The CRAB strain was resistant to all cefuroxime,imipenem,and meropenem,but had a high resistance rate to cefoperazone,ceftazidime,ciprofloxacin,levofloxacin,tobramycin,amikacin,gentamicin,and compound sulfamethoxazole.It showed high sensit

关 键 词：多重耐药菌 临床分布 规范化护理管理 

分 类 号：R47[医药卫生—护理学]