摘要
目的研究分析多药耐药菌(MDROs)的构成、变迁、分布及预防控制措施,减少MDROs医院感染的发生和传播。方法医院2011年1月-2013年12月采用BD phoeniX 100全自动微生物鉴定药敏系统和CLSI指南对临床分离菌进行鉴定、药敏试验和MDROs检测,应用医院感染实时监控系统和PDCA原理开展MDROs预防和控制。结果 1 492株MDROs中产ESBLs大肠埃希菌占32.51%、耐甲氧西林金黄色葡萄球菌(MRSA)占25.34%、产ESBLs肺炎克雷伯菌占18.70%、多药/泛耐药鲍氏不动杆菌占12.67%、多药/泛耐药铜绿假单胞菌占8.98%、耐万古霉素肠球菌占1.81%;主要分布在重症医学科、神经外科、儿科及呼吸内科,分别占20.24%、11.73%、10.66%及8.38%;社区感染、医院感染、定植分别占60.86%、34.65%、4.42%;运用PDCA原理预防控制后病原学送检率、手卫生依从率分别从33.81%和35.88%提高至50.53%和92.13%,抗菌药物使用率、使用强度分别从66.30%和39.10DDDs下降至53.07%和37.14DDDs。结论 MDROs是临床感染性疾病的重要病原菌,合理运用PDCA原理预防控制MDROs,有助于持续改进微生物学实验室检测,促进抗菌药物合理使用,减少耐药菌的产生和医院传播。
OBJECTIVE To research and analyze the composition, transformation, distribution and prevention and control measures of multidrug-resistant organisms （MDROs）, so as to reduce the occurrence and dissemination of MDRO nosocomial infections. METHODS The clinical isolated organisms were undergoing identification, drug sensitive test and MDROs test through the BD Phoenix 100 full-automatic microorganism identification and drug sensitivity system and CLSI guideline from Jan. 2011 to Dec. 2013. The real-time monitoring system of hospital infection and PDCA principle were used to prevent and control MDROs. RESULTS Among the 1492 strains of MDROs, Escherichia coli, which produced ESBLs, accounted for 32. 51%, MRSA held 25. 34%, Klebsiella pneumonia, which produced ESBLs accounted for 18. 70%, MDR/PDR-AB took up 12. 67%, MDR/PDR-PA occupied 8. 98%, and VRE accounted for 1. 81%. The main distribution of MDROs was in ICU （20.24%）, neural surgical （11. 73%）, pediatrics （10.66%）, and respiratory medicine （8. 38%）. The rates of community acquired infections, nosocomial infections, and microorganism colonization were 60.86%, 34.65% and 4.42%, respectively. The pathogenic detection rate and hand hygiene compliance rates increased from 33. 81% and 35.88% to 50.53% and 92.13%, and the rates ＂of antibiotic use and using intensity were decreased from 66.3% and 39.10 DDDs to 53.07M and 37.14 DDDs after using principles of PDCA control. CONCLUSIONS MDROs are important pathogens in clinical infectious diseases. The measures of preventing and controlling MDROs by PDCA principles help to continuously improve the microbiology laboratory testing, promote the rational use of antimicrobials, and reduce the spread and appearance of drug-resistant bacteria in hospitals.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第3期589-591,共3页
Chinese Journal of Nosocomiology
基金
广西卫生厅科技基金资助项目(Z2013114)
关键词
多药耐药菌
医院感染
抗菌药物
PDCA
Multidrug-resistant Organisms
Nosocomial infection
Antimicrobial
PDCA
