多重耐药菌医院感染特点及耐药性分析

目的 了解延安某附属医院多重耐药菌(MDRO)感染现状及耐药特点,以指导临床合理使用抗菌药物。方法 送检标本按“全国临床检验操作规程”进行细菌分离培养,采用全自动微生物分析仪进行细菌鉴定及药敏试验,用WHONET5.6软件进行统计分析。结果 2014年该院共检出病原菌2495株,其中MDRO 404株,检出率为16.2%。革兰阴性菌377株(93.3%),革兰阳性菌27株(6.7%)。MDRO排在前五位的是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌。MDRO在分泌物中检出率最高,为35.9%,其次为尿液和痰液。科室主要分布在普外科、肛肠科、泌尿外科等外科系统。革兰阴性MDRO除对丁胺卡那、亚胺培南、特治星耐药率低于29.2%外,其余均较高。结论 该院MDRO以革兰阴性菌为主,且对常用抗菌药物耐药率高,故临床应高度重视MDRO的动态监测,以便合理使用抗菌药物。

Hospital infection characteristics of multi-resistantbacteria and drug resistance analysis

Objective To explore the clinical feature and antibiotic resistance of nosocomial infection caused by multi-drug resistant organisms( MDRO),and to provide reference for clinical treatment and prevention measure of hospital infection.Methods The samples were separated and cultured according to the“National Clinical Laboratory Procedures”,using automatic microorganism analyzer for bacteria identification and susceptibility testing,WHONET 5.6 software for statistical analysis.Results 2495 pathogens were collected in the hospital in 2014,in which MDRO were 404 strains,the detection rate was 16.2%.Gram-negative bacteria were 377 strain(93.3%),and Gram-positive bacteria were 27 strains(6.7%).The first five MDRO were Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii and Staphylococcus aureus. The highest detection rate of MDRO was in secretion (35.9%),followed by urine,and then sputum,and MDRO located mainly in the general surgery department,anorectal section,urinary surgery and other surgical systems departments.The resistant rates of Gram-negative MDRO were all high except imipenem,amikacin,tazocin with less than 29.2%.Conclusion The hospital main MDRO is Gram-negative bacteria,and have higher resistant rate to commonly used antibiotics. The drug dynamic of MDRO should attach great importance for rational use of antimicrobial drugs.