多重耐药菌耐药性及其多学科协作模式防控效果

Drug resistant of multidrug-resistant organisms and prevention and control effectiveness of multidisciplinary collaboration mode

  • 摘要:
    目的 回顾性分析2022-2023年住院患者多重耐药菌(MDRO)感染的耐药性特征及多学科协作(MDT)后的效果, 以期为MDRO感染防控和医院感染防控管理提供科学依据。
    方法 以2022年1月-2023年12月简阳市人民医院监测的639例MDRO感染住院患者为研究对象, 收集患者临床资料, 分析细菌耐药性特征, 并比较MDT及药学监护对MDRO感染患者治疗效果的影响。
    结果 639例MDRO感染患者的病原菌主要为耐甲氧西林金黄色葡萄球菌(359株, 占56.18%);其次是耐碳青霉烯类肺炎克雷伯菌(96株, 占15.02%), 耐碳青霉烯类鲍曼不动杆菌(82株, 占12.83%);MDRO感染患者主要分布在重症医学科(150例, 占23.47%)、儿科(94例, 占14.71%)和大外科(82例, 占12.83%)。药敏结果显示利奈唑胺、达托霉素、万古霉素和替加环素均对金黄色葡萄球菌敏感, 未出现耐药;大部分革兰阴性菌对碳青霉烯类抗菌药物敏感, 但鲍曼不动杆菌对常见抗菌药物耐药水平较高。实施MDT及药学监护后, MDRO医院总检出率(14.32%)、发生MDRO医院感染例次率(0.05%)更低, 且MDRO患者的治疗有效率(76.47%)高于实施前, 差异均有统计学意义(均P<0.05)。
    结论 开展MDT及药学监护可改善MDRO感染患者治疗效果, 有利于降低MDRO检出率、医院感染率。

     

    Abstract:
    OBJECTIVE To retrospectively analyze the drug resistance characteristics of the patients with multidrug-resistant organisms (MDROs) infections who were hospitalized from 2022 to 2023 and observe the effect of multidisciplinary teamwork (MDT) mode so as to provide scientific bases for prevention and control of MDROs infections and hospital-associated infections.
    METHODS A total of 639 patients with MDROs infection who were hospitalized in Jianyang People′ s Hospital from Jan. 2022 to Dec. 2023 were recruited as the research subjects. The clinical data were collected from the patients, the drug resistance characteristics of bacteria were analyzed. The effects of MDT and pharmacological supervision on treatment of the patients with MDROs infection were observed and compared.
    RESULTS The methicillin-resistant Staphylococcus aureus (MRSA) (359 strains, 56.18%) was dominant among the pathogens isolated from the 639 patients with MDROs infections, followed by the carbapenem-resistant Klebsiella pneumoniae (CRKP) (96 strains, 15.02%) and carbapenem-resistant Acinetobacter baumannii (82 strains, 12.83%). Of the patients with MDROs infection, 150 (23.47%) were from critical care medicine department, 94 (14.71%) from pediatrics department, and 82 (12.83%) from general surgery department. The result of drug susceptibility test showed that the S. aureus strains were susceptible to linezolid, daptomycin, vancomycin and tigecycline; most of the gram-negative bacteria were susceptible to carbapenems, while the A. baumannii strains were highly resistant to the commonly used antibiotics. The total isolation rate of MDROs and the case-time infection rate of MDROs infections were 14.32% and 0.05%, respectively, after MDT and pharmacological supervision were carried out, lower than those before carried out; the effective treatment rate of the patients with MDROs was 76.47% after MDT and pharmacological supervision were carried out, higher than that before they were carried out, and there were significant differences (all P < 0.05).
    CONCLUSION MDT and pharmacological supervision may improve the curative effect of the patients with MDROs infection and reduce the isolation rate of MDROs as well as the incidence of hospital-associated infections.

     

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