6种常见多重耐药菌目标性监测分析

目的监测多重耐药菌(MDRO)在院内的分布,分析其耐药性以控制其在医院内传播。方法对苏州高新区人民医院2011年1～12月临床送检标本中分离鉴定出的6种常见MDRO目标性监测资料进行统计分析。结果临床共分离出1 415株病原菌,其中目标性监测的MDRO 300株,包括产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、耐碳青霉烯类鲍曼不动杆菌及多药耐药铜绿假单胞菌,它们占所检出的相应种属病原菌的百分比分别是39.62%(126/318)、22.11%(44/199)、63.63%(56/88)、5.88%(5/85)、32.07%(17/53)、39.39%(52/132);MDRO主要来自痰液及中段尿标本,分别为45.00%、31.33%;由MDRO引起的社区获得性感染占50.67%(152/300),医院获得性感染占23.33%(70/300);大肠埃希菌和肺炎克雷伯菌(无论是否产ESBLs)对丁胺卡那、头孢西丁及碳青霉烯类有较高的敏感性,对头孢唑啉、头孢他啶、头孢呋辛耐药;鲍曼不动杆菌对亚胺培南、美罗培南耐药率分别为11.32%、20.75%,对其他抗菌药物耐药率均大于50.00%,对头孢西丁、头孢呋辛全部耐药;金黄色葡萄球菌对利奈唑胺、万古霉素全部敏感。结论加强MDRO尤其是社区MDRO监管,合理使用抗菌药物,防治其引起的呼吸道及泌尿道感染是院内感染的防控重点。

Targeted antimicrobial surveillance and analysis in 6 strains of familiar multi-drug-resistant organism

Objective To monitor the distribution of multi-drug-resistant organism（MDRO）,and to analyze their resistance to antimicrobial agents in order to control the spread of infection in the hospital.Methods Six strains of MDRO identified from different clinical specimens were carried out targeted antimicrobial surveillance and then analyzed.Results 1 415 strains of pathogenic bacteria were isolated,and 300 species of MDRO——including extended spectrum beta-lactamas producing Escherichia Coli and Klebsiella Pneumoniae,meticillin-resistant Staphylococcus aureus（MRSA）,Vancomycin resistant enterococci（VRE）,carbapenemas-resistant Acinetobacter baumannii（CR-AB）and multi-drug-resistant Pseudomonas aeruginosa（MRPA）——were monitored through targeted surveillance,the ratio of which were 39.62%,22.11%,63.63%,5.88%,32.07%,39.39%,respectively.Among all of the 300 strains MDRO,the major sources of infection were respiratory tract and urinary tract,which accounted for 45.00% and 31.33%,respectively.The rates of community-acquired infection and hospital-acquired infection caused by MDRO were 50.67%（152/300） and 21.33%（70/300）,respectively.Escherichia Coli and Klebsiella Pneumoniae exhibited sensitivity to amikacin,cefoxitin and carbapenemas,but exhibited resistance to cefazolin,ceftazidime and cefuroxime.Though most of the Acinetobacter baumannii were carbapenemas-sensitive relatively（the resistance rates of CR-AB to imipenem and meropenem were 11.32% and 20.75%,respectively）,it exhibited a resistance rate of more than 50.00% to other antibiotics.All Acinetobacter baumannii strains were resistant to cefoxitin and cefuroxime.All staphylococcus aureus strains were sensitive to Linezolid-and vancomycin-.Conclusion In order to control nosocomial infection,especially the infection of respiratory tract and urinary tract caused by MDRO,a great importance should be attached to the use of antimicrobial agents rationally based on effective supervision and management of community-acquired infection caused by MDRO.