临床分离多重耐药菌的分布及变化趋势

目的了解2013年至2015年多重耐药菌(MDROs)的分布及变化趋势,为临床有效控制多重耐药菌(MDROs)感染提供依据。方法应用WHONET5.6软件,对2013年至2015年主要MDROs分布及变化趋势进行分析。结果 2013年至2015年共分离出病原菌2232株,其中多重耐药菌株(MDROs)896株,占全部病原菌的40.1%;主要MDROs构成比依次为ESBL-ECO(30.1%)、CRAB(20.0%)、MRSCNS(13.2%)、ESBL-KPN(10.5%)、MDRPA(7.9%)、MRSA(4.7%);896株多重耐药菌主要分布在重症医学科、老年科、神经外科、泌尿外科、神经内科,临床分离出主要多重耐药菌株最多的标本为痰(42.3%),依次是中段尿(19.6%)、血液(19.2%)、分泌物(10.7%);ESBL-ECO三年检出率相对稳定;2015年ESBL-KPN检出率(37.0%),明显低于2013年(52.8%)、2014年(56.7%);2015年MRSCNS检出率(78.0%),明显低于2014年(96.6%)、2013年(83.0%);2015年MDRPA检出率(14.1%)低于2013年(26.4%)、2014年(33.7%);2015 CRAB年检出率(68.7%),低于2013年(77.4%)、2014年(83.7%);MRSA2015年检出率(37.5%),较2013年(31.2%)、2014年(27.0%)有所增加;特殊耐药菌株CRKPN检出率三年保持稳定(4.0%、4.5%、4.1%),2015年CRPA检出率(12.5%)显著低于2014年(28.9%),2015年CRECO检出率(2.5%)高于2013年(0%)、2014年(0.8%)。结论多重耐药菌已逐渐成为医院感染的主要病原菌,我院CRAB检出率较高,MRSA、CRECO有逐年增高的趋势,应采取综合措施进行积极有效的预防与控制。

Types and trends of infection caused by clinically isolated multi-drug resistant organisms

Objective To analyze types distribution and developing trends of multi-drug resistant organism (MDROs) infection from 2013 to 2015,so as to provide reference for preventing and controlling MDRO healthcare-associated infection(HAI). Methods A retrospective review of MDRO records has been conducted throughout the period from January 2013 to December 2015. Organ-isms identified and tested by an automated identification and susceptibility system were analyzed with WHONET5.6. Results A total of 2232 bacteria strains were isolated,896 (40.1%) of which were MDROs. Of all MDROs,ESBL-ECO (30.1%),CRAB(20. 0%),MRSCNS(13.2%),ESBL-KPN(10.5%),MDRPA(7.9%),MRSA(4.7%) was isolated respectively,and mainly distributed in intensive care unit,geriatrics Dept,neurosurgery Dept,urology Dept,neurology Dept,respectively. The MDRO strains mainly isolat-ed from:sputum specimens (42.3%),and was followed by the middle of urine (19.6%),blood (19.2%),discharge (10.7%). ESBL-E-CO in 3 years detection rate is relatively stable;ESBL-KPN in 2015 detection rate (37.0%),significantly lower than in 2013(52. 8%),2014(56.7%). MRSCNS in 2015 detection rate (78.0%),significantly lower than in 2014(96.6%),2013(83.0%). 2015 MDRPA detection rate (14.1%) less than 2013(26.4%),2014(33.7%). CRAB in 2015 detection rate (68.7%),lower than in 2013(77.4%), 2014(83.7%);2015 MRSA detection rate(37.5%),compared with 2013(31.2%),2014(27.0%) increased;As special resistant strains, CRKPN detection rate in 3 years remained stable (4.0%,4.5%,4.1%),2015 CRPA detection rate (12.5%) was significantly lower than in 2014 (28.9%),2015 CRECO detection rate (2.5%) than in 2013 (0%),2014 (0.8%). Conclusion Multiple drug-resistant bacteria has gradually become the main pathogenic bacteria in nosocomial infection,CRAB detection rate is higher in our hospital, MRSA,CRECO increase year by year,comprehensive measures should be taken to carry on the positive and effective prevention and control.