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目的:探讨我院感染病原菌的临床分布特点及耐药现状,为临床用药提供指导,为医院感染控制提供循证依据。方法:对我院2014年7月1日至2015年6月30日住院患儿发生医院感染的病原菌分布特点及耐药情况进行回顾性分析。结果:临床科室送检的44 451份标本中,明确为医院感染的病原菌1 034株,其中革兰阴性菌693株(67.02%),革兰阳性菌232株(22.44%),真菌109株(10.54%)。病原菌检出的标本依次为痰(526株)、静脉血(197株)、支气管灌洗液(62株)、尿(56株)、分泌物(50株)、穿刺液(49株)及大便(36株)等。病原菌检出科室主要为新生儿科(198株)、血液肿瘤科(148株)、重症医学科(127株)、心胸外科(134株)、肾脏免疫科(63株)。多重耐药菌336株,以革兰阴性菌为主,分别为鲍曼不动杆菌(52株)、大肠埃希菌(50株)、肺炎克雷伯菌肺炎亚种(45株)、肺炎链球菌(33株)、金黄色葡萄球菌(25株)、铜绿假单胞菌(15株)等;主要的多重耐药菌对青霉素类、头孢菌素类耐药率高。结论:我院医院感染病原菌以革兰阴性菌为主,对常用的抗菌药物耐药率较高,感染部位以呼吸道、血液感染为主,感染对象主要是危重患儿和免疫力低下患儿。此结果提示,医院感染管理科要有针对性的监控重点部门,指导其减少易感因素,重视病原菌培养,合理使用抗菌药物,降低医院感染发生率。
Objective: To investigate the clinical distribution and drug resistance of pathogenic bacteria in our hospital, provide guidance for clinical medication and provide evidence base for nosocomial infection control. Methods: A retrospective analysis of the distribution characteristics and drug resistance of hospital-acquired nosocomial infections in our hospital from July 1, 2014 to June 30, 2015 was conducted. Results: Of the 44 451 specimens examined in the clinical departments, 1 034 were confirmed as pathogenic bacteria of hospital infection, of which 693 were gram-negative bacteria (67.02%), 232 (22.44%) were gram-positive bacteria and 109 were 10.54%). The samples of pathogen were sputum (526), venous blood (197), bronchial lavage fluid (62), urine (56), secretions (50), puncture fluid (49) and stool (36 strains) and so on. Pathogenic bacteria detection departments are mainly neonatal (198 strains), hematological oncology (148 strains), Department of Critical Care Medicine (127 strains), cardiothoracic surgery (134 strains), and Kidney Immunology (63 strains). 336 strains of multidrug-resistant bacteria, Gram-negative bacteria are mainly Acinetobacter baumannii (52 strains), Escherichia coli (50 strains), Klebsiella pneumoniae pneumonia (45 strains), pneumonia Streptococcus (33 strains), Staphylococcus aureus (25 strains), Pseudomonas aeruginosa (15 strains); the main multi-resistant strains of penicillins, cephalosporins resistance rate. CONCLUSIONS: Gram-negative bacteria are the main pathogenic bacteria in hospitals in our hospital. Resistant to commonly used antimicrobial agents is high. The main infection areas are respiratory tract and blood infection. Infected patients are mainly critically ill children and immunocompromised children. This result suggests that the hospital infection management department should have targeted monitoring key departments to guide the reduction of susceptibility factors, emphasis on pathogen culture, rational use of antimicrobial agents, reduce the incidence of nosocomial infections.