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目的通过对医院近三年临床标本检出耐碳青霉烯类肠杆菌科细菌(CRE)患者进行实时监控分析,对临床经验性治疗及感染控制给予帮助。方法 2013年1月1日-2015年12月31日通过院感实时监控系统进行前瞻性全面综合性监测,判定医院感染、院外感染或定植,研究标本及菌种来源、发现率变化、感染部位分布特征等。结果 2013-2015年共检出CRE分离菌株111株,其中35株为医院感染菌株、59株为院外感染菌株、17株为定植菌,呼吸道标本占50.45%、血液标本占6.31%、其他无菌体液标本占13.51%;主要菌种来源:肺炎克雷伯菌占59.46%,大肠埃希菌占25.23%;2013-2015年院内CRE发现率波动在0.108‰~0.224‰,院内、院外及定植CRE发现率波动在0.346‰~0.734‰;院内及院外CRE感染部位分布主要为下呼吸道感染,占46.81%,发生7例呼吸机相关性肺炎医院感染,腹(盆)腔组织及腹水感染占12.77%,其中9例为院外感染。结论 2013-2015年CRE发现率呈上升趋势,感染以下呼吸道为主,防止CRE的产生需对患者高危因素进行评估,进一步降低感染风险,同时合理使用抗菌药物。
Objective To monitor real-time monitoring of patients with carbapenem-resistant enterobacteriaceae (CRE) in clinical specimens from hospitals in the past three years, and to help them with clinical experience and infection control. Methods From January 1, 2013 to December 31, 2015, we conducted prospective, comprehensive and comprehensive monitoring through hospital-based real-time monitoring system to determine the nosocomial infection, out-of-hospital infection or colonization, and to study the origin of the samples and strains, the change of the detection rate, Distribution features. Results A total of 111 strains of CRE isolates were detected in 2013-2015, of which 35 were hospital-acquired strains, 59 were hospital-acquired strains, 17 were colonized with bacteria, respiratory specimens accounted for 50.45%, blood specimens accounted for 6.31%, and other sterile The main species was Klebsiella pneumoniae (59.46%) and Escherichia coli (25.23%). The detection rate of in-hospital CRE was between 0.108 ‰ and 0.224 ‰ in 2013-2015. The in-vitro and out-of-hospital CRE The detection rate fluctuated from 0.346 ‰ to 0.734 ‰. The distribution of CRE infection in hospital and outside the hospital was mainly lower respiratory tract infection, accounting for 46.81%, 7 cases of nosocomial pneumonia associated with ventilator-associated pneumonia occurred, and abdominal cavity and pelvic cavity infection accounted for 12.77% Nine of them were nosocomial infections. Conclusion The detection rate of CRE increased from 2013 to 2015, and the respiratory tract was the main source of infection. To prevent the production of CRE, the risk factors of the patients should be evaluated to further reduce the risk of infection and rational use of antimicrobial agents.