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目的了解医院多药耐药菌(MDROs)感染,并根据MDROs分布及药敏试验结果实施有效干预措施,指导临床合理使用抗菌药物,减少发生MDROs感染。方法采用医院感染实时监控系统前瞻性对某医院2014年1月1日-10月31日住院患者MDROs感染及菌株、药敏试验结果进行监测分析,应用WHONET5.4软件统计药敏试验数据。结果 40 334例住院患者中发生医院感染752例、907例次,感染率1.86%、例次感染率2.25%;从痰液、血液等送检标本中分离出998株病原菌,其中MDROs 308株,检出率30.86%;检出的MDROs以革兰阴性菌为主,共231株占75.00%,以鲍氏不动杆菌居为主,革兰阳性菌71株占23.05%,以金黄色葡萄球菌为主,真菌6株占1.95%;住院患者发生MDROs感染的主要病区为综合楼ICU、外科楼ICU、神经血管外科和神经创伤外科,分别占20.78%、17.53%、11.36%和9.42%。结论利用前瞻性监测医院MDROs感染,即时发现问题,针对性的采取物体表面环境、空气、手卫生监测、严格执行消毒隔离制度等现场干预措施,同时规范临床合理使用抗菌药物,可有效降低MDROs感染的发生。
Objective To understand the infection of multidrug-resistant bacteria (MDROs) in hospitals and to implement effective interventions according to the distribution of MDROs and drug susceptibility test results to guide clinical rational use of antimicrobial agents and reduce the incidence of MDROs infection. Methods The real-time monitoring system of nosocomial infection was used to prospectively monitor and analyze the MDROs infection and susceptibility test results of inpatients from January 1, 2014 to October 31, 2014 in a hospital. Drug susceptibility test data were collected using WHONET 5.4 software. Results Among 40 334 inpatients, 752 hospital infections occurred in 907 cases, the infection rate was 1.86% and the infection rate was 2.25%. 998 pathogens were isolated from the sputum and blood samples, of which 308 were MDROs, The detection rate was 30.86%. The majority of MDROs were detected in Gram-negative bacteria, accounting for 75.00% of total 231 strains, mainly Acinetobacter baumannii, 71 strains of Gram-positive bacteria accounting for 23.05%, Staphylococcus aureus 6 fungi accounted for 1.95%. The main wards of inpatients with MDROs infection were ICU, ICU, neurovascular surgery and neurosurgery in inpatients, accounting for 20.78%, 17.53%, 11.36% and 9.42% respectively. Conclusions The prospective monitoring of hospital MDROs infection, immediate detection of the problem, targeted to the surface environment, air, hand hygiene monitoring, strict implementation of disinfection and isolation system and other field interventions, while regulating clinical rational use of antimicrobial agents, can effectively reduce the MDROs infection happened.