多学科合作管理多重耐药菌的效果

摘要

Objective To investigate the detection of multidrug-resistant organisms (MDROs)in a hospital, evaluate the efficacy of multi-disciplinary team(MDT)on management of MDROs,and provide guidance for effective control on MDRO infection.Methods From October 2013 to September 2014,compliance to comprehensive inter-vention measures in clinical departments in different stages as well as detection of MDROs from patients were com-pared respectively.Results Compliance to comprehensive intervention measures showed an overall upward trend from the fourth quarter of 2013 to the first,second,and third quarters of 2014,difference was statistically signifi-cant (all P <0.001 ).From the fourth quarter of 2013 to the third quarter of 2014,the percentage of the major MDRO strains in the same species of bacteria were:methicillin-resistant Staphylococcus aureus (MRSA)52.34%, 45.45%,48.95%,and 26.25% respectively;carbapenem-resistant Acinetobacter baumannii (CRAB)64.42%, 63.07%,59.87%,and 43.09% respectively;multidrug-resistant Pseudomonas aeruginosa (MDRPA)42.11 %, 41 .82%,29.33%,and 17.52% respectively;the detection rate of MRSA,CRAB,and MDRPA showed an overall downward trend,difference among different stages were statistically significant (all P <0.001 ).Detection rates of carbapenem-resistant Enterobacteriaceae (CRE)and vancomycin-resistant Enterococcus (VRE)were both low (<5%),difference among different stages were not statistically significant (all P >0.05).Conclusion MDT on man-agement of MDROs is helpful for reducing the emergence and spread of MDROs.%目的：了解医院多重耐药菌（MDRO）检出情况，评价多学科合作管理 MDRO 的效果，为临床有效控制MDRO 感染提供依据。方法比较某院2013年10月—2014年9月不同时段临床科室各项干预措施依从性及患者 MDRO 检出情况。结果2013年第4季度，2014年第1、2、3季度4个不同时段各项控制措施依从率总体呈现上升趋势，差异均有统计学意义（均 P ＜0．001）。2013年第4季度—2014年第3季度主要监测 MDRO 在同种菌中检出率：耐甲氧西林金黄色葡萄球菌（MRSA）分别为52．34％、45．45％、48．95％、26．25％；耐碳青霉烯类鲍曼不动杆菌（CRAB）分别为64．42％、63．07％、59．87％、43．09％；多重耐药铜绿假单胞菌（MDRPA）分别为42．11％、41．82％、29．33％、17．52％；MRSA、CRAB、MDRPA 检出率总体呈现下降趋势，不同时段检出率比较，差异均有统计学意义（均 P ＜0．001）。耐碳青霉烯类肠杆菌科细菌（CRE）、耐万古霉素肠球菌（VRE）检出率低（＜5％），各时段比较，差异均无统计学意义（均 P ＞0．05）。结论积极推行多学科合作 MDRO 管理模式，有利于降低 MDRO的产生与传播。