目的 分析我院和重症监护室(ICU)患者多重耐药菌(multidrug resistant organism,MDRO)检出率、分布及变化发展趋势,探讨多重耐药菌(MDRO)感染预防和控制策略.方法 应用细菌学监测方法对全院1401株及ICU分离的189株MDRO进行数据分析.结果 在我院1401株MDRO中,前3位MDRO是大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌,是我院MDRO感染的主要致病菌,以大肠埃希菌为主,共669株(47.8％),其中产ESBLs 507株(75.8％,507/669),非产酶株162株(24.2％,162/669),耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA) 184株(13.1％),肺炎克雷伯菌共173株(12.3％),其中产ESBLs 127株(73.4％,127/173),非产酶株46株(26.6％,46/173).ICU共分离多重耐药菌189株,占全院总阳性率13.4％.ICU前3位MDRO是肺炎克雷伯菌共47株,其中产ESBLs的39株(83.0％,39/47),非产酶株8株(17.0％,8/47),多重耐药鲍曼不动杆菌37株(19.6％),大肠埃希菌34株,其中产ESBLs 25株(73.5％,25/34),非产酶株9株(26.5％,9/34).我院MDRO检出率呈下降趋势,从2014年13.0％降至2016年7.3％,ICU MDRO从13.4％降8.6％.结论 我院及ICU多重耐药菌主要来源呼吸道标本,处理对策应从阻遏耐药菌传播和产生着手,合理使用抗菌药物,加强手卫生,防止多重耐药茵医院暴发流行.%Objective To analyze the detection rate,the distribution,and trends of multi-drug resistant organism (MDRO) for patients in our whole hospital and intensive care unit (ICU),and to discuss the prevention and control strategies of MDRO infections.Methods Bacteriological monitoring methods were used to analyze the data of 1401 MDRO strains and 189 MDRO strains isolated from the whole hospital and ICU,respectively.Results Among the 1401 MDRO strains in the hospital,the top three MDROs were Escherichia coli,Staphylococcus aureus,and Klebsiella pneumoniae,which were also the main pathogens of MDRO infections in the hospital.Among 669 MDROs (47.8％) of Escherichia coil,507 strains (75.8％,507/669) produced ESBLs and 162 strains (24.2％,162/669) did not produce ESBLs.Besides,there were 184 strains (13.1％,184/1401) of oxacillin-resistant Staphylococcus aureus (MRSA) and 173 strains (12.3％,173/1401) of Klebsiella pneumonia,among which 127 strains (73.4％,127/173) produced ESBLs and 46 strains (26.6％,46/173) did not produce ESBLs.A total of 189 MDROs were isolated from ICU,accounting for 13.4％ of MDRO strains in the whole hospital.The top three MDROs for ICU were 47 strains of Klebsiella pneumoniae,37 strains of Acinetobacter and 34 strains of Escherichia coli.39 strains (83.0％,39/47) of Klebsiellapneumonia and 25 strains (73.5％,25/34) ofEscherichia coli produced ESBLs.The detection rate of MDROs in the hospital showed a downward trend,from 13.0％ in 2014 to 7.3％ in 2016.The detection rate of MDROs in ICU decreased from 13.4％ to 8.6％.Conclusion Respiratory specimens were the main specimen source of MDROs in the hospital and ICU.Strategies should be done to stop the production and spread of resistant bacteria.In addition,it is also important to use antimicrobial drugs rationally,strengthen hand hygiene,and prevent the outbreak of MDROs in hospitals.
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