烧伤中心分离菌变迁趋势及院内感染综合防控的研究

目的了解烧伤病房细菌变迁趋势,为临床抗感染治疗提供依据,制定并实施针对性综合防控措施,减少或避免院内感染的发生。方法收集2001年至2008年间本院烧伤中心不同来源标本细菌培养结果;分析对比实施院感综合防控措施前后各一年,烧伤重症监护病区（BICU）空气及环境采样细菌培养结果;通过部分耐药鲍曼不动杆菌基因分型研究,了解该菌患者间交叉传播情况。结果 8年间列前五位的病原菌分别是金黄色葡萄球菌（31.4%）、铜绿假单胞菌（19.1%）、不动杆菌（12.7%）、大肠埃希菌（6.2%）、阴沟肠杆菌（5.4%）。分年度排名显示,不动杆菌检出率近年来明显上升,2006年后升至第二位,2008年超过金黄色葡萄球菌成为检出率最高的细菌。实施院感综合防控措施前后各一年BICU空气采样合格率分别为80.5%及95.8%（P〈0.01）,环境采样细菌培养合格率分别为82.3%及97.0%（P〈0.01）,差异均有统计学意义。随机引物扩增DNA指纹图谱检测未见相同基因型鲍曼不动杆菌在患者间传播。结论 8年间烧伤病房的检出细菌谱发生明显变化,不动杆菌近年来超过以往最多见的金黄色葡萄球菌和铜绿假单胞菌上升为第一位,且主要为广泛耐药的鲍曼不动杆菌,对危重烧伤患者的救治构成威胁。综合防控措施对减少病区内感染机会,尤其是细菌的交叉传播能起到明显效果。

Changing tendency of pathogenic bacteria and control of nosocomial infection in a burn center

Objective To analyze the changing tendency of pathogenic bacteria and to control the nosocomial infection by comprehensive means in a burn center. Methods Results of bacteria culture from 2001 to 2008 were collected and analyzed. Year pass rates of air and environment culture before and after the administration of comprehensive infection control strategies were compared. Nosocomial transmission among patients was analyzed by random amplified polymorphic DNA（RAPD）for some drug resistant acinetobacter baumannii. Results The first five bacteria for the eight years were Staphylococcus aureus （31.4%）, Pseudomonas aeruginosa（19.1%）, Acinetobacter（12.7%）, Escherichia coli （6.2%）and Enterobacter cloacae（5.4%）. Ranking by year showed that the rank of acinetobacters has increased quickly in recent years, ranking second after 2006 and reaching the first in 2008 surpassing Staphylococcus aureus. Year pass rates of air culture before and after the administration of comprehensive infection control strategies were 80.5% and 95.8% respectively （P0.01）, and those of environment culture before and after were 82.3% and 97.0% respectively （P0.01）. No nosocomial transmission of the tested Acinetobacter baumannii among patients was found by RAPD typing. Conclusion The distribution of pathogenic bacteria has been changing greatly in the eight years. Surpassing the highest Staphylococcus aureus and Pseudomonas aeruginosa of the past, rank of acinetobacters has reached the highest in recent years, most of which were pan-drug resistant Acinetobacter baumannii that may threaten the treatment of extensive burn patients. The comprehensive infection control strategies used were helpful in decreasing the chance of nosocomial infection, especially the nosocomial transmission of the pathogenic bacteria.