临床分离多重耐药菌感染类型及变化趋势

Types and changing trend of infection caused by clinically isolated multidrug resistant organisms

摘要:

目的了解多重耐药菌（MDRO）感染类型及变化趋势，为MDRO医院感染的预防与控制提供依据。方法对某三级甲等综合教学医院2010年10月1日—2013年9月30日分离的细菌及MDRO进行分析。结果共分离细菌5 223株，MDRO占23.22%（1 213株）。经趋势χ2检验，MDRO所占比例逐年上升（χ2=16.885，P＜0.001）。1 213株MDRO中，医院感染455株（37.51%），社区感染613株（50.54%），定植112株（9.23%），污染33株（2.72%）。2010—2013年，MDRO医院感染所占比例呈下降趋势（χ2=13.477，P＜0.001），社区感染（χ2=6.579，P=0.01）及定植（χ2=4.536，P=0.033）所占比例呈上升趋势。感染部位以呼吸系统（997株，84.49%）为主，其次为泌尿系统、皮肤和软组织、血液系统等。结论MDRO感染形势严峻，其社区感染及定植患者的管理成为医院感染预防与控制的重点。

Abstract:

ObjectiveTo realize types and changing trends of multidrug resistant organism(MDROs) infection, so as to provide reference for preventing and controlling  MDRO healthcareassociated  infection (HAI) . MethodsBacteria and MDROs isolated from patients in a general hospital from October 1, 2010 to September 30,2013 were analyzed. ResultsA total of 5 223 bacteria strains were isolated, 1 213 (23.22%) of which were MDROs. χ2 trend test showed that the percentage of MDROs increased year by year (χ2=16.885, P<0.001).Of all MDROs, rate of HAI strains ,communityassociated infection (CAI) strains, colonized strains ,and contamination strains were 37.51%(n=455), 50.54%(n=613) , 9.23%(n=112) , and 2.72%(n=33) respectively . From 2010 to 2013, the percentage of MDRO HAI showed decreased trend (χ2=13.477,P<0.001), CAI and colonization showed increased  trend (χ2=4.536, P=0.033) ,the main infection site was respiratory tract(84.49%，n=997) ,followed by urinary tract , skin and soft tissue, and bloodstream.  ConclusionMDRO infection become more and more serious,management of patients with MDRO CAI  and colonization  has become the focus of HAI prevention and control.