| BackgroundMany clinical severe infection, refractory infection was effectively controlled with the continuous research of antimicrobial drugs and widely used, while some pathogens have also developed resistance to antimicrobial drugs in the course of treatment. The majority of patients with multiple drug-resistant infections are those who in critical condition, with many basic diseases, used broad-spectrum antimicrobial drugs and long-term indwelling catheter, etc., who without effective treatment and control of infection will lead to high mortality and other patients with critically ill infection. Multi-drug-resistant infections caused by clinical experience is one of the main reasons for failure of medication, resulting in patients not achieve the desired therapeutic effect, thereby extending the length of hospital stay, increase patient medical expenses.In recent years, the State Development Planning Commission has strengthened the supervision of the use of antimicrobial drugs in medical institutions, the multiple drug-resistant infections into the hospital infection monitoring indicators. It has been reported that the detection rate of multidrug-resistant bacterial infection and the rate of drug resistance have been increasing year by year in tertiary general hospitals, but less in the clinical distribution and drug-resistance of multi-drug resistant strains in tertiary hospitals.ObjectivesThe objective of this study was to investigate the distribution of multidrug-resistant bacteria in different age, population, department, specimen, disease and drug resistance of the hospitalized patients in a three-level general hospital, and analyze the overall infection rate of multiple drug-resistant bacteria the status of infection of multiple drug-resistant bacteria in the general hospital, in order to guide clinicians timely and accurate choice of antimicrobial drugs, and provide the basis for prevention and control of multiple drug-resistant infections, which is of great significance to prevent and reduce the risk of multiple drug-resistant infections.Methods1. Subjects:Results of pathogenic bacteria detection were collected a third-class hospital from January 1,2013 to December 31,2015.2.Statistical analysis:Quantitative variables that met the normal distribution were expressed as mean ± standard deviation (SD). For variables that did not meet the normal distribution were expressed as the median quartiles, the lower quartile [M (Q25, Q75)]; categorical variables are expressed in frequency (n) and frequency (%). The x,2 test was used to compare the categorical variables. The Fisher exact test was used when the ?2 test conditions were not satisfied. The rank sum test was used to compare the quantitative variables that did not fit the normal distribution.p<0.05 was considered statistically significant.Results1. Inpatients with multiple drug-resistant detection:a total of 54,128 people were discharged from January 1,2013 to December 31,201,2851 multiple drug-resistant strains were detected, the rate of multi-resistant bacteria found was 5.27%; The rate of multiple drug-resistant bacteria was 36.16%.2. Analysis of the distribution of multiple drug-resistant Acinetobacterbaumannii infection and the resistance rate of various antibiotics:the multiple drug-resistant Acinetobacterbaumannii in different gender, age, department, the detection rate of specimens was statistically significant (P<0.01). The resistant rate of multidrug-resistant Acinetobacterbaumannii were more than 90% in Cephalosporins (99.2%), quinolones (98.1%), aminoglycosides (95.4%), carbapenems (93.4%) and sulfonamides (91.9%). The drug-resistant rates of Acinetobacterbaumannii were significantly different (p<0.01) in different sex, age, department and samples.3. The distribution characteristics of'multidrug-resistant Pseudomonas aeruginosa and the analysis of drug resistance rate of various antibiotics:The detection rate of multidrug-resistant Pseudomonas aeruginosa in different sexes, departments, samples and diseases was statistically significant (P<0.01). And the resistance rate of ?-lactam antibiotics (71.9%) was more than 70% to Pseudomonas aeruginosa with ?-lactamase inhibitors (84.7%), cephalosporins (75.8%), quinolones (73.7%), and carbapenems (75.8%). The drug resistance rate of Acinetobacterbaumannii was significantly higher than that of non-multi-drug resistant strains (P<0.01). There were significant differences in drug-resistant rate among different sex, age, department, and specimen (p<0.01).4. The distribution of methicillin-resistant Staphylococcus aureus (MRSA) and the resistance rate to various antibiotics were analyzed. There were significant differences in the detection rate of MRSA in different departments and samples (p<0.01). (97.4%), penicillins (96.9%) and rindamines (86.5%) were the top three antimicrobial agents, the difference was statistically significant (P<0.01). There were significant differences in drug resistance rate among different departments, samples, and MRSA(p<0.01).5. Distribution of Enterobacteriaceae Isolated from ESBLs and Analysis of Resistance to Various Antibiotics:ESBLs-producing Escherichia coli, Klebsiellapneumoniae and Proteus-like Proteins in Different Age, Department andDisease (P<0.01), the detection rate of the top three departments are hepatobiliary surgery, ICU, general surgery. The resistance rate to sulfonamides, cephalosporins and quinolones was more than 70%. There were significant differences in the resistance rate of ESBLs-producing Enterobacteriaceae bacteria among different ages, departments, samples and disease patients (p<0.01).Conclusions1. Methicillin-resistant Staphylococcus aureus, producing extended-spectrum ?-lactamases Enterobacteriaceae bacteria, multiple drug-resistant Acinetobacterbaumannii, Multidrug-resistant Pseudomonas aeruginosa were the mainly Multi-drug-resistant bacteria in tertiary hospital. Carbapenem-resistant Enterobacteriaceae bacteria, vancomycin-resistant enterococci detection rate is low.2. Multiple drug-resistant rate bacteria detection rate was higher in ICU, hepatobiliary surgery, respiratory medicine, neurosurgery department than other department in hospital.3. Glycopeptides (vancomycin), carbapenems (imipenem, meropenem), tetracyclines (tigecycline, minocycline) maintain a high sensitivity to the clinical common multi-drug-resistant bacteria; The resistance rate of methicillin-resistant Staphylococcus aureus to macrolides, penicillins and lincomycin was high; The resistant rates of multiple antibiotic-resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae-producing bacteria to cephalosporins, quinolones and aminoglycosides were higher. |
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