摘要
目的通过对医院近三年临床标本检出耐碳青霉烯类肠杆菌科细菌（CRE）患者进行实时监控分析,对临床经验性治疗及感染控制给予帮助。方法 2013年1月1日-2015年12月31日通过院感实时监控系统进行前瞻性全面综合性监测,判定医院感染、院外感染或定植,研究标本及菌种来源、发现率变化、感染部位分布特征等。结果 2013-2015年共检出CRE分离菌株111株,其中35株为医院感染菌株、59株为院外感染菌株、17株为定植菌,呼吸道标本占50.45%、血液标本占6.31%、其他无菌体液标本占13.51%;主要菌种来源：肺炎克雷伯菌占59.46%,大肠埃希菌占25.23%;2013-2015年院内CRE发现率波动在0.108‰~0.224‰,院内、院外及定植CRE发现率波动在0.346‰~0.734‰;院内及院外CRE感染部位分布主要为下呼吸道感染,占46.81%,发生7例呼吸机相关性肺炎医院感染,腹（盆）腔组织及腹水感染占12.77%,其中9例为院外感染。结论 2013-2015年CRE发现率呈上升趋势,感染以下呼吸道为主,防止CRE的产生需对患者高危因素进行评估,进一步降低感染风险,同时合理使用抗菌药物。
OBJECTIVE To carry out the real-time monitoring of the patients of whom the clinical specimens were detected the carbapenem-resistant Enterobacteriaceae（CRE）in recent three years so as to provide guidance for empirical therapy and infection control.METHODS From Jan 1,2013 to Dec 31,2015,the prospective,comprehensive monitoring was carried out by using real-time monitoring system for nosocomial infections so as to determine the healthcare-associated infections,community-associated infections,or colonization.The sources of specimens and species,change of isolation rate,and distribution of infection sites were observed.RESULTS A total of111 CRE absolute isolates were detected from 2013 to 2015,of which 35 strains were isolated from the healthcareassociated infection cases,59 strains were isolated from the community-associated infection cases,and 17 strains were colonized isolates.Among the specimen sources obtained,the respiratory tract specimens accounted for50.45%,the blood specimens accounted for 6.31%,and other aseptic body fluid specimens accounted for13.51%.Of the major species of the isolated pathogens,59.46% were Klebsiella pneumoniae,and 25.23% were Escherichia coli.The isolation rate of the CRE strains isolated from the healthcare-associated infection cases ranged between 0.108‰ and 0.224‰in 2013-2015;the isolation rate of the CRE strains isolated from the community-associated infection cases and colonized cases varied from 0.346‰to 0.734‰.Of the healthcare-associated and community-associated CRE infection cases,46.81% had lower respiratory tract infection,7had ventilator-associated pneumonia,and 12.77% had abdominal（pelvic cavity）tissue and ascites infection,of whom 9had the community-associated infection.CONCLUSIONThe isolation rate of the CRE strains shows an upward trend from2013 to 2015,and the lower respiratory tract is dominant among the infection sites.It is necessary to evaluate the high risk factors to further reduce the risk of infection and reasonably use antibiotics so as to prevent the emergence of CRE strains.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第18期4189-4191,共3页
Chinese Journal of Nosocomiology
基金
中国医院协会医院感染预防与控制能力建设项目(CHA-2012-XSPX-0629-1)
贵州省科技厅基金项目(黔科合LS字2012-017)
贵州省科技厅基金项目(黔科合SY字2010-3138)
贵州省科技厅基金项目(黔科合J字2009-2170)
贵州省科学技术基金项目(gzwkj2012-1-114)
关键词
CRE
感染特征
发生率
变迁
思考
CRE
Characteristic of infection
Incidence
Change
Thinking
