2018年度某三甲综合医院常见多重耐药菌的科室分布特点及耐药性分析

目的分析陆军军医大学第二附属医院2018年度多重耐药菌(MDRO)的临床分布及其对常用抗菌药物的耐药性,为医院感染的防控及临床合理利用抗菌药物提供依据。方法采用回顾性分析方法,抽取该院2018年1-12月的5368例住院患者送检标本中多重耐药菌检测情况和细菌药敏试验数据,统计分析多重耐药菌的临床分布特点及其耐药情况。结果2018年度本院共检出多重耐药菌848株,检出菌株量排前5位的分别是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌;多重耐药菌在痰液标本中的检出率为最高,其次为血液标本、伤口标本和尿标本;检测出的耐甲氧西林金黄色葡萄球菌(MRSA)对糖肽类、硝基呋喃类、恶唑酮类抗菌药物极其敏感,对于氨基糖苷类和喹诺酮类抗菌药物的敏感率≥75%,而对于青霉素类、大环内酯类和林可霉素类抗菌药物的耐药率极高;耐碳青霉烯类大肠埃希菌对碳青霉烯类抗菌药物耐药率极低,而对青霉素类、头孢菌素类、氨基糖苷类、氟喹诺酮类抗菌药物均显示出较高的耐药率耐碳青酶烯类铜绿假单胞菌(CR-PAE)对多黏菌素B极为敏感,对氨基糖苷类的阿米卡星与喹诺酮类的环丙沙星耐药率相对较低,对β-内酰胺酶类、头孢菌素类、碳青霉烯类等抗菌药物的耐药率较高,而对于β-内酰胺类与酶抑制剂复合物的耐药率较低。结论医院多重耐药菌感染日益严重,应该加强对多重耐药菌株的监控,根据送检药敏结果合理选用抗菌药物治疗,加强医护人员多重耐药菌预防控制知识和手卫生培训,严格落实消毒隔离措施,从而有效预防和控制多重耐药菌的感染和暴发。

Clinical distribution and drug resistance of multidrug-resistant bacteria in a third-grade general hospital in 2018

Objective We analyzed the multi-resistant bacteria(multidrug-resistant organism,MDRO)of clinical distribution and the drug resistance to commonly used antimicrobial agents of the second affiliated hospital of army medical university in 2018 to prevent and control the hospital infection and provide evidences for clinical rational use of antimicrobial agents.Methods A retrospective analysis method was used,the data of testing multi-resistant bacteria and bacterial susceptibility of 5368 hospitalized patients in 2018 were collected to analyze the distribution characteristics of multi-resistant bacteria and the drug resistance effects.Results A total of 848 strains of multi-resistant bacteria were confirmed and the top five were Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus and E.coli;there was a highest detection rate in sputum specimens,followed by blood specimens,wound and urine specimens.Detected multiple drug resistant gram-positive bacteria were extremely sensitive to antibiotics of sugar peptide,nitrofurans and pbo ketone,and multiple drug resistant gram-negative bacteria were relatively sensitive to cefoperazone/shu ba jotham,amikacin and tigecycline.However,they showed resistance to clinical commonly used antimicrobial agents.Conclusion The hospital multi-resistant bacteria infection are becoming severe,we should strengthen the monitoring of multiple drug resistant strains,use antimicrobial drugs reasonably according to the result of inspection susceptibility,emphasize the multi-resistant bacteria prevention and the knowledge of hand hygiene among medical staff,strictly implement disinfection and isolation measures so as to effectively prevent and control the multi-resistant bacteria infections and outbreaks.