| BackgroundWith the continuous advancement and development of modern medical technology,the widespread application of invasive procedures,the irrational and frequent use of various antibiotics,and the non-standard treatment of chronic inflammation,the number of cases of nosocomial infections and multi-drug resistant bacterial infections has increased many.Due to the complexity and intractability of infection caused by multi-drug resistant bacteria,it also poses a great challenge for clinical anti-infective treatment.It has now become a serious problem in the field of infection.Therefore,in order to enable medical personnel to better understand the characteristics of the multi-drug resistant bacteria strains in the hospital,such as the distribution of departments and drug resistance trends,and to take reasonable treatment and prevention and control measures as soon as possible,so as to improve the level of diagnosis and treatment of medical institutions and effective prevention and control of hospitals Infection,specially for this study.Objectives1.To explore the distribution pattern of multi-drug resistant bacteria in the pediatric departments of this hospital and the change of discovery rate;2.Analyze the drug resistance rates of various types of multi-drug resistant bacteria,and provide basis for clinicians’empirical diagnosis and treatment;3.According to the detection source of multi-drug resistant bacteria,to provide protection basis for preventing patients from cross-infection;4.Through the analysis of the characteristics of multi-drug resistant bacteria in nosocomial infection cases,the clinical medical personnel are guided to carry out targeted treatment,nursing and prevention and control work.MethodsWe retrospectively analyzed the data of 573 cases of multi-drug resistant bacteria isolated from the inspection samples from January 1,2014 to December 31,2016 in each pediatric department of the First Affiliated Hospital of Xinxiang Medical University.The basic data of the eligible patients(gender,age,source of specimens,distribution of departments,composition of multi-drug resistant bacteria),the cases of nosocomial infections for multi-drug resistant bacterial infections,and the results of bacterial susceptibility testing were analyzed.Results1.The discovery rate of multi-drug resistant bacteria was 2.91%(301/10357)in 2014,1.80%(161/8943)in 2015,and 1.37%(111/8087)in 2016.The overall incidence of methicillin-resistant Staphylococcus aureus,Escherichia coli and Klebsiella pneumoniae,multidrug-resistant Acinetobacter baumannii,and multidrug-resistant Pseudomonas aeruginosa with a downward trend,the discovery rate of carbapenem-resistant Enterobacteriaceae bacteria is on the rise.2.The distribution of multi-drug resistant bacteria and the composition ratio:214cases of G~+bacteria,accounting for 37.35%,359 cases of G~-bacteria,accounting for62.65%.The detection rates of each multi-drug resistant bacteria strain were:Methicillin-resistant Staphylococcus aureus(206 cases,35.95%),Escherichia coli producing extended-spectrum beta-lactamase(101 cases,17.62%),Multi-drug resistant Acinetobacter baumannii(98 cases,17.11%),Klebsiella pneumoniae(91 cases,15.88%)producing extended-spectrum beta-lactamase,multi-drug resistant Pseudomonas aeruginosa(55 cases)(9.60%),carbapenem-resistant enterobacteriaceae(14 cases,2.44%),vancomycin-resistant enterococci(8 cases,1.40%).3.The distribution and composition ratio of the 573 cases of multi-drug resistant bacteria isolated were:PICU(201 cases,35.08%),neonatology(171 cases,29.84%),general pediatrics(201 cases,35.08%),in the above departments The detection rates were:21.80%(201/922),3.99%(171/4281),and 0.91%(201/22184).4.In the case of nosocomial infections,there were 100 cases of multi-drug resistant bacterial infections,accounting for 8.02%(100/1247)of patients in the pediatrics general hospital from 2014 to 2016,including 44 cases(3.53%)in 2014 and 40 cases in 2015.(3.21%)and 16 cases(1.28%)in 2016.The multi-drug resistant bacteria that developed nosocomial infection were mainly MDR-AB(49 cases,49.00%).5.Clindamycin,erythromycin,levofloxacin,gentamycin,and tetracycline remained above 40%resistant to MRSA between 2014 and 2016,while vancomycin,teicoplanin,and compound sulfamethoxazole against MRSA The resistance rate is above 40%.The resistance rates of sulfamethoxazole,gentamycin,and ciprofloxacin in ESBL-producing E.coli were more than 40%,and the antibiotics whose resistance rate was less than 40%were imipenem,meropenem,and cefoxitin,piperacillin/tazobactam,amikacin.The resistance rate to ESBL Klebsiella pneumoniae was more than 40%with cefotaxime,ceftazidime and gentamicin,and the resistance rate to cefotaxime was the highest,meropenem,imipenem,cefoxitin,Amikacin,etc.,has a resistance rate below 40%.Multi-drug resistant Acineto-bacter baumannii(MDR-AB)is highly resistant to all antibacterial drugs.There are many cases of all drug resistance,only some of which are sensitive to amikacin and ciprofloxacin.Multidrug-resistant Pseudomonas aeruginosa had high sensitivity to various antibiotics,and there was no significant change in drug resistance trend in the past three years.Conclusions1.The incidence of multi-drug resistant bacteria showed a downward trend as a whole,but the incidence of carbapenem-resistant enterobacteriaceae(CRE)has increased.The resistance rate of multi-drug resistant bacteria is still very severe.2.The top five cases of multi-drug resistant bacteria were methicillin-resistant Staphylococcus aureus,ESBLs-producing Escherichia coli,and multidrug-resistant Acinetobacter baumannii,Production of extended-spectrumβ-lactamases(ESBLs)in Klebsiella pneumoniae and multidrug-resistant Pseudomonas aeruginosa.Among them,methicillin-resistant Staphylococcus aureus ranks first.3.The overall number of cases of nosocomial infection in cases of multi-drug resistant bacterial infections showed a downward trend. |
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