摘要
目的本研究以赴日培训为契机,评价和分析两所日本综合性医院管理多药耐药革兰阴性菌医院感染的经验与教训。方法在现场考察和专访记录的基础上,以两所医院对多药耐药革兰阴性菌的医院感染管理为切入点,整理的数据部分来自培训资料,部分收集于公开发表的文献和医院的宣传出版物。结果不同耐药类型的革兰阴性杆菌对隔离预防的效果不一样,与非发酵菌相比,多药耐药肠杆菌科细菌感染的发生率持续升高;正确使用抗菌药物的项目管理以及感染控制措施的监督执行,并未能持续降低住院患者ESBLs的阳性检出率;产ESBL的埃希氏菌医院感染的暴露负担和感染负担均比肺炎克雷伯菌更严重。结论合理使用抗菌药物的管理项目和标准的医院感染控制措施必须双管齐下;评估对多药耐药革兰阴性菌的医院感染控制效果时须进行感染风险系数调整;分子流行病学在医院感染管理领域的转化性应用和研究需要进一步加强。
OBJECTIVE To evaluate and analyze the experience and lessons of control of multidrug‐resistant gram‐negative bacteria infections in two general hospitals in Japan by taking the opportunity of training in Japan . METHODS On the basis of onsite inspection and personal interviews ,the management of the nosocomial infections caused by the multidrug‐resistant gram‐negative bacteria was set as the entry point ,some of the data were collect‐ed from the training materials ,and some of the data were collected from published literatures and advocacy publi‐cations of the hospitals .RESULTS The different drug resistance phenotypes of gram‐negative bacilli varied in the effect of isolation and prevention .As compared with the non‐fermenting bacteria ,the incidence of multidrug‐re‐sistant Enterobacteriaceae infection was continuously increased .The reasonable use of antibiotics and implementa‐tion of infection control measures could not continuously reduce the positive rate of detection of ESBLs in the hos‐pitalized patients .Both the exposure burden and infection burden of the ESBLs‐producing Escherichia were heavier than those of the ESBLs‐producing K lebsiella pneumoniae .CONCLUSION It is necessary to further stress the com‐bination of reasonable use of antibiotics with standard infection control measures ,adjust the infection risk coeffi‐cient when evaluating the effect on the control of multidrug‐resistant gram‐negative bacteria nosocomial infections , and further strengthen the conversion application and research of molecular epidemiology in the nosocomial infec‐tion control field .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第22期5228-5231,共4页
Chinese Journal of Nosocomiology
基金
国家科技部中日合作卫生技术人员培训项目(国科外字(2014)3046号)
关键词
医院感染
多药耐药菌
革兰阴性菌
培训项目
Nosocomial infection
Multidrug-resistant bacteria
Gram-negative bacteria
Training program
