CAJ | 학술논문

目的：了解多重耐药菌(multiple resistant bacteria)感染的状况，为制定医院感染管理预防控制措施提供资料。方法：回顾性分析我院2012年1月至2013年12月间分离到的1340株多重耐药菌感染的住院患者资料。结果：从送检的15108例各类标本中共分离出病原菌9355株，其中多重耐药菌1341株，占14.33%。1341株多重耐药菌中革兰阴性杆菌占60.18%，革兰阳性菌占39.82%。主要菌种依次为产ESBL大肠埃希菌（386株）、耐甲氧西林凝固酶阴性葡萄球菌（314株）、产ESBLs肺炎克雷伯菌（223株）、耐甲氧西林金黄色葡萄球菌（219株）、多重耐药鲍曼不动杆菌（137株）、多重/泛耐药铜绿假单胞菌（48株）、其他（14株）。痰液标本分离率最高，检出率48.70%；其次为中段尿标本，检出率24.83%；再者为伤口创面分泌物，检出率13.42%。多重耐药菌的年份分布：2012年检出558株；2013年检出783株。发生医院感染的科室以神经外科、泌尿外科、呼吸内科和肾内科为主；感染部位以呼吸道、泌尿道和伤口创面感染为最常见；多重耐药革兰阴性杆菌对阿莫西林、头孢唑啉、头孢呋辛钠、氨苄西林、头孢他啶、头孢吡肟、头孢曲松、头孢噻肟等8种我院临床常用的抗菌药物耐药率超过84%，对碳青酶稀类和三代头孢的复方制剂仍比较敏感，对其他的抗菌药物也出现不同程度的耐药。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌对我院临床常用的头孢唑林、青霉素G、头孢西丁、阿莫西林/棒酸、头孢克洛、头孢哌酮/舒巴坦和克拉霉素等抗菌药物耐药率达到88%以上，对万古霉素和米诺环素敏感，对其他的抗菌药物也出现不同程度的耐药。结论：此状况应引起医院的高度重视，加强抗菌药物使用的管理，制定出具有针对性的预防控制措施，遏制日趋严重的多重耐药菌感染。目的：瞭解多重耐藥菌(multiple resistant bacteria)感染的狀況，為製定醫院感染管理預防控製措施提供資料。方法：迴顧性分析我院2012年1月至2013年12月間分離到的1340株多重耐藥菌感染的住院患者資料。結果：從送檢的15108例各類標本中共分離齣病原菌9355株，其中多重耐藥菌1341株，佔14.33%。1341株多重耐藥菌中革蘭陰性桿菌佔60.18%，革蘭暘性菌佔39.82%。主要菌種依次為產ESBL大腸埃希菌（386株）、耐甲氧西林凝固酶陰性葡萄毬菌（314株）、產ESBLs肺炎剋雷伯菌（223株）、耐甲氧西林金黃色葡萄毬菌（219株）、多重耐藥鮑曼不動桿菌（137株）、多重/汎耐藥銅綠假單胞菌（48株）、其他（14株）。痰液標本分離率最高，檢齣率48.70%；其次為中段尿標本，檢齣率24.83%；再者為傷口創麵分泌物，檢齣率13.42%。多重耐藥菌的年份分佈：2012年檢齣558株；2013年檢齣783株。髮生醫院感染的科室以神經外科、泌尿外科、呼吸內科和腎內科為主；感染部位以呼吸道、泌尿道和傷口創麵感染為最常見；多重耐藥革蘭陰性桿菌對阿莫西林、頭孢唑啉、頭孢呋辛鈉、氨芐西林、頭孢他啶、頭孢吡肟、頭孢麯鬆、頭孢噻肟等8種我院臨床常用的抗菌藥物耐藥率超過84%，對碳青酶稀類和三代頭孢的複方製劑仍比較敏感，對其他的抗菌藥物也齣現不同程度的耐藥。耐甲氧西林金黃色葡萄毬菌和耐甲氧西林凝固酶陰性葡萄毬菌對我院臨床常用的頭孢唑林、青黴素G、頭孢西丁、阿莫西林/棒痠、頭孢剋洛、頭孢哌酮/舒巴坦和剋拉黴素等抗菌藥物耐藥率達到88%以上，對萬古黴素和米諾環素敏感，對其他的抗菌藥物也齣現不同程度的耐藥。結論：此狀況應引起醫院的高度重視，加彊抗菌藥物使用的管理，製定齣具有針對性的預防控製措施，遏製日趨嚴重的多重耐藥菌感染。
목적：료해다중내약균(multiple resistant bacteria)감염적상황，위제정의원감염관리예방공제조시제공자료。방법：회고성분석아원2012년1월지2013년12월간분리도적1340주다중내약균감염적주원환자자료。결과：종송검적15108례각류표본중공분리출병원균9355주，기중다중내약균1341주，점14.33%。1341주다중내약균중혁란음성간균점60.18%，혁란양성균점39.82%。주요균충의차위산ESBL대장애희균（386주）、내갑양서림응고매음성포도구균（314주）、산ESBLs폐염극뢰백균（223주）、내갑양서림금황색포도구균（219주）、다중내약포만불동간균（137주）、다중/범내약동록가단포균（48주）、기타（14주）。담액표본분리솔최고，검출솔48.70%；기차위중단뇨표본，검출솔24.83%；재자위상구창면분비물，검출솔13.42%。다중내약균적년빈분포：2012년검출558주；2013년검출783주。발생의원감염적과실이신경외과、비뇨외과、호흡내과화신내과위주；감염부위이호흡도、비뇨도화상구창면감염위최상견；다중내약혁란음성간균대아막서림、두포서람、두포부신납、안변서림、두포타정、두포필우、두포곡송、두포새우등8충아원림상상용적항균약물내약솔초과84%，대탄청매희류화삼대두포적복방제제잉비교민감，대기타적항균약물야출현불동정도적내약。내갑양서림금황색포도구균화내갑양서림응고매음성포도구균대아원림상상용적두포서림、청매소G、두포서정、아막서림/봉산、두포극락、두포고동/서파탄화극랍매소등항균약물내약솔체도88%이상，대만고매소화미낙배소민감，대기타적항균약물야출현불동정도적내약。결론：차상황응인기의원적고도중시，가강항균약물사용적관리，제정출구유침대성적예방공제조시，알제일추엄중적다중내약균감염。
Objective:To explore the conditions of multiple resistant bacteria, infecting and provide data for prevention and control measures of hospital infection management. Methods: Information of inpatients who were infected by 1340 strains of multiple drug-resistant bacteria which were separated during January 1,2012 to December 31,2013 were retrospectively analysed.Methods:Information of inpatients who were infected by 1340 strains of multiple drug-resistant bacteria which were separated during January 1,2012 to December 31,2013 were retrospectively analysed.Results:There were 9355 pathogenic bacteria from the inspected 15108 samples, among which multi-drug resistant bacteria were 1341, accounting for 14.33%. Among the latter, 60,18% were Gram staining negative bacilli,and 39.82% were Gram positive bacteria . Major strains are ESBL producing e. coli (386 strains), methicillin-resistant coagulase negative staphylococcus (314 strains), ESBLs producing pneumonia klebsiella bacteria (223 strains), methicillin-resistant staphylococcus aureus (219 strains), multiple drug resistant acinetobacter baumannii (137 strains), multiple/generic drug resistant pseudomonas aeruginosa (48 strains), other (14 strains). Detection rate of sputum specimens was on the top, that was 48.70% ; Followed by the middle part of urine specimens, the detection rate was 24.83%.Followed was wound secretion, detection rate is 13.42%. The time distribution of multi-resistant bacteria was 558 in 2012,and 783 in 2013.Nosocomial infection most frequently occurred in neurology surgery department,urology surgery department, respiratory medicine department and urology medicine department,among them,respiratory tract, urinary tract and wound infection is the most common kinds.More than 84% of multi-resistant gram-negative bacilli resist to eight kinds of most frequently used antimicrobial, which are amoxicillin, cefazolin, cefuroxime sodium, ampicillin, cephalosporins he organism, cefepime, ceftriaxone, and cefotaxime. But they still sensitive to carbapenem and third generation cephalosporins compound preparations.For other antimicrobial,they were resisted in different levels. More than 88% methicillin-resistant staphylococcus aureus and methicillin-resistant coagulase negative staphylococcus were resisted to cefazolin, penicillin G, cefoxitin, amoxicillin/rods acid, cefaclor, cefoperazone/ Sulbactam Sodium, clarithromycin which are the most common used antimicrobial.They were still sensitive to vancomycin and minocycline,but resisted to other antimicrobial agents in different levels.Conclusions:This situation should arouse attention of the hospital to strengthen the management of antimicrobial use and to develop a targeted prevention and control measures to restrain the ever increasing of multi-resistant bacteria infection.