多重耐药菌感染的预防与控制胡必杰.ppt

耐药菌的难题，远不止NDM-1！ MRSA PDR-不动杆菌 铜绿假单胞菌 艰难梭菌 VRE ESBL，KPC，NDM-1 多重耐药结核分枝杆菌 什么是多重耐药菌？ 多重耐药菌（Multidrug-Resistant Organism，MDRO），主要是指对临床使用的三类或三类以上抗菌药物同时呈现耐药的细菌。 常见多重耐药菌包括耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）、产超广谱β-内酰胺酶（ESBLs）细菌、耐碳青霉烯类抗菌药物肠杆菌科细菌（CRE）（如产Ⅰ型新德里金属β-内酰胺酶[NDM-1]或产碳青霉烯酶[KPC]的肠杆菌科细菌）、耐碳青霉烯类抗菌药物鲍曼不动杆菌（CR-AB）、多重耐药/泛耐药铜绿假单胞菌（MDR/PDR-PA)和多重耐药结核分枝杆菌等。 医院感染越来越险恶！ 案例 某男，90岁，COPD多年，反复感染，近日鲍曼不动杆菌肺部感染 某男，56岁，肺癌术后一周，高热、呼吸衰竭，重症肺炎，鲍曼不动杆菌 某男，22岁，颅脑手术后2周，高热，CSF引流液鲍曼不动杆菌 正确认识接触预防有效控制多重耐药菌MDRO 耐药菌增加的原因 耐药菌产生增加（抗生素选择性压力）：由于医生过多地使用抗生素，造成对基因突变及耐药基因转移的耐药菌进行了筛选 耐药菌传播增加：通过医护人员尤其手的接触，细菌在病人间交叉寄生造成耐药菌株在医院内的传播，以及随后通过宿主病人的转移，耐药菌在医院间甚至社区进行传播 Antimicrobial Resistance恶性循环 National Patient Safety Goals, Hospital Critical Access Hospital, 2009 7c. Prevent multiple drug-resistant organisms (MDRO) infections, especially methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile-associated disease (CDAD). 7d. Prevent catheter-associated BSI (CABSI) 7e. Prevent surgical site infections (SSI) 13a. Patient involvement in their care: respiratory hand hygiene on day of admission – pt. family 美国National Patient Safety Goal NPSG.07.03.01-Implement evidence-based practices to prevent health care-associated infections due to multi-drug resistant organisms (MDRO). These organisms are not transmitted by air. They are spread by contact via hands or contaminated environment. MRSA C. difficile VRE MDR gram negative bacteria Spread of MDROs Can Be Controlled By: Good infection control practices Meticulous hand hygiene for contact with patient and patient’s environment of Standard Precautions Good environmental and equipment cleaning practices HCW knowledge regarding these organisms and how they are spread Judicious use of antibiotics Teaching patient and family FIGHTS Follow isolation practices In-service training for staff Gauging disinfectant efficacy Hand hygiene Testing environmental surfaces Standardized cleaning procedures 卫生部办公厅关于印发《多重耐药菌医院感染预防与控制技术指南（试行）》的通知（2011.1.17） 一、加强多重耐药菌