摘要
目的分析外科住院患者医院感染病原菌种类及耐药性,为医师高效预防控制医院感染、合理应用抗菌药物提供参考依据。方法调查2012年1月-2014年12月2 793例外科住院患者临床资料,筛选出发生医院感染的患者,统计其感染部位等资料;感染病原菌分离与鉴定按细菌检验规范操作,药敏试验采用纸片扩散法,以CLSI每年更新折点确认抗菌药物敏感、中介或耐药,采取WHONET 5.6统计软件进行药敏率分析。结果 3年外科住院患者发生医院感染共268例、331例次,感染率9.6%、例次感染率11.9%;主要感染部位为手术切口、皮肤黏膜、呼吸系统、泌尿系统等;检测出348株病原菌中革兰阴性菌占65.5%、革兰阳性菌占23.8%、真菌占10.7%;除肠杆菌科细菌对碳青霉烯类、革兰阳性菌对糖肽类抗菌药物保持100.0%敏感性外,其他病原菌对抗菌药物表现出多药耐药性,以鲍氏不动杆菌最为突出;耐甲氧西林葡萄球菌检出率为46.8%,产ESBLs菌检出率为47.9%。结论外科住院患者感染病原菌以革兰阴性菌为首,表现出多药耐药性,外科医师应强化感染与规范用药意识,护士应指派专人负责科内流行感染菌的跟踪监控,以保障手术成功率。
OBJECTIVE To analyze species distribution and antimicrobial resistance profiles of pathogenic bacteria,to provide basis for effective prevention and control of nosocomial infections and accurate medication.METHODS RESULTS Medical records of 2 793 hospitalized surgical patients from Jan.2012 to Dec.2014 were reviewed.Those inpatients with nosocomial infections were screened.Information including infection sites was statistically summarized.Isolation and identification of infectious bacteria were performed in accordance with standard operating protocol.Drug sensitivity tests were carried out by KB method using updated CLSI breakpoints to determine antibiotic sensitivity,intermedia or resistance.The WHONET 5.6software was used to analyze the data.RESULTS Among 2793 cases of surgical inpatients,268 patients had nosocomial infections（9.6%）,while the infection case accounted for 331（11.9%）.The main infection sites included operative incision,skin,mucosa membrane,respiratory tract and urinary tract.Among 348 pathogens,gram-negative bacteria,gram-positive bacteria and fungi accounted for 65.5%,23.8% and 10.7%.As to drug sensitivity,except for 100.0%sensitivity of Enterobacteriaceae to carbapenem and 100.0%sensitivity of gram-positive bacteria to glycopeptide antibiotics,surgical infectious bacteria,particularly Acinetobacter baumannii,showed multi-drug resistance to other clinical antibiotics.The isolating rate of methicillin-resistant Staphylococci（MRS）and extended-spectrum beta-lactamases producer（ESBLs）were 46.8% and 47.9%.CONCLUSION Gram-negative bacteria are the main pathogens for infections in hospitalized surgical patients and show multi-drug resistance.Surgeons should strengthen awareness of infections and standard medication.The nurse should be assigned responsible for tracking and monitoring epidemic strains in wards in order to guarantee the success rate of operation.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第5期1162-1164,共3页
Chinese Journal of Nosocomiology
基金
湖北省卫生厅基金资助项目(WJ01564)
关键词
外科
住院患者
医院感染
病原菌
耐药性
Inpatients
Nosocomial infection
Pathogens
Species
Antimicrobial resistance
