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目的探讨医院内多重耐药菌(MDRO)的分布及其耐药性,为临床治疗提供科学指导,预防和延缓MDRO的产生和蔓延,减少医院感染的发生。方法采集2013-2015年本院住院病人的痰液、尿液、渗出液、引流液、脓液、分泌物、咽拭子等各类标本共9525份,按《全国临床检验操作规程》进行接种培养,采用VITEK2-COMPACT全自动微生物仪及配套的鉴定卡对分离的细菌进行鉴定及药敏试验,分析MDRO的分布和耐药性。结果 9525份标本中共分离出病原菌2878株,MDRO有五种,共429株,占14.9%。其中,2013年-2015年MDRO检出率分别为10.8%,16.2%,18.0%(χ~2=21.82,(P<0.01),呈逐年上升趋势。MDRO中,大肠埃希菌最多(66.2%),其次是肺炎克雷伯菌肺炎亚种(23.5%),铜绿假单胞菌(4.4%),鲍曼不动杆菌(3.0%),金黄色葡萄球菌(2.8%)。大肠埃希菌主要分布在尿液,肺炎克雷伯菌肺炎亚种、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌主要分布在痰液。MDRO的科室分布以重症医学科最多。大肠埃希菌、肺炎克雷伯菌肺炎亚种对头孢噻肟、头孢呋辛钠的耐药率均为100%,耐药率>40%的药物有环丙沙星、庆大霉素、头孢他啶,对美罗培南、头孢替坦、亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢吡肟的耐药率<40%。铜绿假单胞菌对头孢噻肟、头孢呋辛钠、头孢曲松耐药率为100%,对环丙沙星、庆大霉素、亚胺培南、左氧氟沙星、哌拉西林/他唑巴坦、阿米卡星、头孢他啶、头孢吡肟、妥布霉素耐药率均>40%。结论 2013-2015年本院MDRO的的检出率逐年增加,且其耐药率相对较高,以尿液和痰液中较多,应加强对抗菌药物使用的监管,加强细菌耐药性的监控,合理使用抗菌药物以控制医院感染和MDRO的产生。
Objective To investigate the distribution and drug resistance of multiple drug-resistant bacteria (MDRO) in hospital and to provide scientific guidance for clinical treatment, to prevent and delay the occurrence and spread of MDRO and to reduce the occurrence of nosocomial infections. Methods A total of 9,525 samples of sputum, urine, exudate, drainage fluid, pus, secretions, throat swab and other samples from inpatients in our hospital from 2013 to 2015 were collected. According to the “National Clinical Laboratory Procedures” Inoculation culture, using VITEK2-COMPACT automatic microbiology instrument and supporting identification card for identification of bacteria isolated and drug susceptibility testing, analysis of MDRO distribution and drug resistance. Results A total of 2878 pathogens were isolated from 9525 samples. There were 5 MDRs, 429 strains, accounting for 14.9%. Among them, the detection rate of MDRO was 10.8%, 16.2% and 18.0% respectively in 2013-2015 (χ ~ 2 = 21.82, P <0.01) ) Followed by Klebsiella pneumoniae pneumonia (23.5%), Pseudomonas aeruginosa (4.4%), Acinetobacter baumannii (3.0%) and Staphylococcus aureus (2.8%). Escherichia coli Mainly distributed in the urine, Klebsiella pneumoniae pneumonia, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus is mainly distributed in the sputum.MDRO department distribution to the most critical medicine subjects. Klebsiella pneumoniae pneumonia, cefotaxime, cefuroxime sodium resistance rates were 100%, drug resistance rate> 40% of ciprofloxacin, gentamicin, ceftazidime, Meropenem, cefotetan, imipenem, piperacillin / tazobactam, amikacin, cefepime resistance rate of <40%. Pseudomonas aeruginosa cefotaxime, cefuroxime Sodium and ceftriaxone were 100% resistant to ciprofloxacin, gentamicin, imipenem, levofloxacin, piperacillin / tazobactam, amikacin, ceftazidime, cefepime, Tobramycin The drug resistance rate was> 40% .Conclusion The detection rate of MDRO in our hospital increased year by year from 2013 to 2015, and its drug resistance rate was relatively high, with more urine and sputum, the use of antibiotics should be strengthened Supervision, to strengthen the monitoring of bacterial resistance, the rational use of antimicrobial drugs to control nosocomial infections and MDRO production.