医院多重耐药菌感染状况调查分析

目的：了解多重耐药菌（multiple resistant bacteria）感染的状况，为制定医院感染管理预防控制措施提供资料。方法：回顾性分析我院2012年1月至2013年12月间分离到的1340株多重耐药菌感染的住院患者资料。结果：从送检的15108例各类标本中共分离出病原菌9355株，其中多重耐药菌1341株，占14.33%。1341株多重耐药菌中革兰阴性杆菌占60.18%，革兰阳性菌占39.82%。主要菌种依次为产ESBL大肠埃希菌（386株）、耐甲氧西林凝固酶阴性葡萄球菌（314株）、产ESBLs肺炎克雷伯菌（223株）、耐甲氧西林金黄色葡萄球菌（219株）、多重耐药鲍曼不动杆菌（137株）、多重/泛耐药铜绿假单胞菌（48株）、其他（14株）。痰液标本分离率最高，检出率48.70%；其次为中段尿标本，检出率24.83%；再者为伤口创面分泌物，检出率13.42%。多重耐药菌的年份分布：2012年检出558株；2013年检出783株。发生医院感染的科室以神经外科、泌尿外科、呼吸内科和肾内科为主；感染部位以呼吸道、泌尿道和伤口创面感染为最常见；多重耐药革兰阴性杆菌对阿莫西林、头孢唑啉、头孢呋辛钠、氨苄西林、头孢他啶、头孢吡肟、头孢曲松、头孢噻肟等8种我院临床常用的抗菌药物耐药率超过84%，对碳青酶稀类和三代头孢的复方制剂仍比较敏感，对其他的抗菌药物也出现不同程度的耐药。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌对我院临床常用的头孢唑林、青霉素G、头孢西丁、阿莫西林/棒酸、头孢克洛、头孢哌酮/舒巴坦和克拉霉素等抗菌药物耐药率达到88%以上，对万古霉素和米诺环素敏感，对其他的抗菌药物也出现不同程度的耐药。结论：此状况应引起医院的高度重视，加强抗菌药物使用的管理，制定出具有针对性的预防控制措施，遏制日趋严重的多重耐药菌感染。

Investigation and analysis of multiple drug-resistant bacteria infection status in hospital

Objective：To explore the conditions of multiple resistant bacteria, infecting and provide data for prevention and control measures of hospital infection management. Methods： Information of inpatients who were infected by 1340 strains of multiple drug-resistant bacteria which were separated during January 1,2012 to December 31,2013 were retrospectively analysed.Methods：Information of inpatients who were infected by 1340 strains of multiple drug-resistant bacteria which were separated during January 1,2012 to December 31,2013 were retrospectively analysed.Results：There were 9355 pathogenic bacteria from the inspected 15108 samples, among which multi-drug resistant bacteria were 1341, accounting for 14.33%. Among the latter, 60,18% were Gram staining negative bacilli,and 39.82% were Gram positive bacteria . Major strains are ESBL producing e. coli （386 strains）, methicillin-resistant coagulase negative staphylococcus （314 strains）, ESBLs producing pneumonia klebsiella bacteria （223 strains）, methicillin-resistant staphylococcus aureus （219 strains）, multiple drug resistant acinetobacter baumannii （137 strains）, multiple/generic drug resistant pseudomonas aeruginosa （48 strains）, other （14 strains）. Detection rate of sputum specimens was on the top, that was 48.70% ; Followed by the middle part of urine specimens, the detection rate was 24.83%.Followed was wound secretion, detection rate is 13.42%. The time distribution of multi-resistant bacteria was 558 in 2012,and 783 in 2013.Nosocomial infection most frequently occurred in neurology surgery department,urology surgery department, respiratory medicine department and urology medicine department,among them,respiratory tract, urinary tract and wound infection is the most common kinds.More than 84% of multi-resistant gram-negative bacilli resist to eight kinds of most frequently used antimicrobial, which are amoxicillin, cefazolin, cefuroxime sodium, ampicillin, cephalosporins he organism, cefepime, ceftriaxone, and cefotaxime. But t