急诊科病房耐药细菌感染的类型及相关因素分析

摘要

Objective To analyze the distribution and characteristics of multiple drug resistant bacteria in the emergency ward of our hos-pital. Methods During January and July in 2015,clinical information of 95 bacterial culture positive patients in our hospital were collected. These patients were divided into non multidrug resistant organisms( MDRO ) group,multidrug resistance/extensively drug resistant bacteria ( MDR/XDR)group,and pandrug resistant( PDR)group. The relationship between serum PCT levels,days of hositalization and drug sensitivity/resistance of pathogen were analyzed. Results 135 strains of pathogenic bacteria were obtained in emergency department,including 57 strains in general ward and and 78 strains in intensive care unit. Specimens from respiratory tract accounted for 76. 30%. The top three were Bauman acine-tobacters(36. 3%),Klebsiella pneumoniae(17. 0%)and Staphylococcus aureus(10. 4%),respectively. Staphylococcus aureus,Enterococcus faecium(5. 2%)and Enterococcus faecalis(4. 4%)were main members of gram positive bacteria while most common gram positive bacteria were Bauman acinetobacters,Klebsiella pneumoniae,Pseudomonas and aeruginosa bacteria(8. 9%). The median length of hospital stay were 12 days in the non MDR group,14 days in MDR/XDR group,and 28 days in the PDR group respectively. The non MDR group had significantly different length of hospital stay compared with the other two groups( P =0. 003),and it was significantly different. The PDR group had longest hospital stay. The median serum procalcitonin levels of non MDR,MDR/XDR and the PDR group were ﹤0. 05 μg/L,0. 12 μg/L,0. 16 μg/L respec-tively. It was significantly different( P =0. 03)compared with that in the non MDR group. Conclusion The prevalence rate of multidrug resist-ant bacteria infection in emergency department ward is high,accompanying with prolonged hospitalization time. Monitoring the levels of PCT in pa-tients with multidrug resistant bacteria infection ,rational use of antibiotics,effective application of disinfection and isolation measures are condu-cive to prevention and control of multiple drug resistant bacteria infection.%目的：分析急诊科病房发生多重耐药细菌的分布及耐药特点。方法采用回顾性调查急诊科2015年1月至7月细菌培养阳性患者95例，分成非多重耐药菌（ MDR）组、多重耐药/泛耐药菌（ MDR/XDR）组、全耐药菌（ PDR）组，比较降钙素原（ PCT）、住院天数与病原菌药敏及耐药性的关系。结果共检测出135株病原菌，其中综合病房57株，EICU 78株；标本来源以呼吸道为主，占76.30%。前三位分别是鲍曼不动杆菌（36.3%）、肺炎克雷伯菌（17.0%）、金黄色葡萄球菌（10.4%）；其中G＋菌主要为金黄色葡萄球菌、屎肠球菌（5.2%）、粪肠球菌（4.4%）；G-菌主要为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌（8.9%）等。住院天数非MDR组14.90±6.30 d与MDR/XDR组20.77±15.96 d、PDR组38.29±37.45 d比较差异有显著性（ P =0.003）。血PCT水平三组中位数分别为小于0.05μg/L、0.12μg/L、0.16μg/L；与非MDR组比较，差异有统计学意义（ P =0.03）。结论急诊科病房多重耐药细菌感染发生率高，使住院时间明显延长。应监测多重耐药菌患者PCT水平，合理使用抗生素，采取有效的消毒隔离措施，预防和控制多重耐药菌院内感染。