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目的了解医院骨科住院患者医院感染多重耐药菌分布及耐药性,为临床合理应用抗菌药物提供科学依据。方法采用回顾性调查方法,对某部队医院骨科146例住院患者感染多重耐药菌种类分布及耐药性进行统计分析。结果连续2年该医院骨科住院患者送检病原学标本中共检出病原菌448株,其中多重耐药菌146株,占检出病原菌数的32.59%。检出多重耐药菌主要包括耐甲氧西林金黄色葡球菌(MRSA)、产β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌、多耐药铜绿假单胞菌(MDR-PA)。大肠埃希菌和肺炎克雷伯菌对部分头孢类抗菌药物耐药率超过90%,但对碳青霉烯类比较敏感;金黄色葡萄球菌对50%以上的抗菌药物耐药率均超过90%,仅对利奈唑胺、万古霉素和替考拉宁等较敏感。结论该医院骨科患者多重耐药菌感染率较高,ESBLs大肠埃希菌居首位,均严重耐药,严格管理抗菌药物应成为主要防控措施。
Objective To understand the distribution and drug resistance of multiple drug-resistant bacteria in nosocomial hospital patients with orthopedic inpatients, and to provide a scientific basis for rational use of antimicrobial agents in clinical practice. Methods The retrospective investigation method was used to analyze the distribution of multidrug-resistant bacteria in hospitalized patients in 146 orthopedic departments of a military hospital and the drug resistance. Results A total of 448 pathogenic bacteria were detected in etiological specimens of hospitalized orthopedic patients for two consecutive years, of which 146 strains were multi-drug resistant, accounting for 32.59% of the total number of pathogens detected. The multi-resistant strains were detected mainly including methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Klebsiella pneumoniae producing β-lactamases (ESBLs), multi-resistant Pseudomonas aeruginosa (MDR -PA). Escherichia coli and Klebsiella pneumoniae resistant to some cephalosporins more than 90%, but more sensitive to carbapenems; Staphylococcus aureus more than 50% of the antibiotic resistance rates were more than 90 %, Only linezolid, vancomycin and teicoplanin more sensitive. Conclusions The prevalence of multidrug-resistant bacteria in orthopedic patients in this hospital is high. ESBLs-producing Escherichia coli ranks the first place with serious drug resistance. Strict management of antimicrobial agents should be the main prevention and control measure.