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Госпитальные инфекции PowerPoint PPT Presentation


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Госпитальные инфекции. Михайлова М.В. Клинический фармаколог СПб МАПО. Определение ВОЗ. Нозокомиальные инфекции ( nosocomium - лат. nosokomeo - греч. - больница) любое инфекционное заболевание, которое возникает У госпитализированных больных после 48 часов пребывания в стационаре

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Госпитальные инфекции

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..


  • ( nosocomium- .

    nosokomeo- . - )

    ,

    • 48

  • ,

  • ,


  • (APACHEII > 15)

  • >60

  • (, )


85%

25,6%

46,9%

17,6%

12%

6,9%

5,1%

4,8%

4,5%

:CNS, S.aureus, Enterococcus spp

:P.aerug., S.aureus, Enterobacter spp., K.pneum.

.:Enterococcus spp., CNS, S.aureus, P.aerug.

. :E.coli, C.albicans, Enterococcus spp, P.aerug.

EPICn=2064 (1417 , 10038 )

Vincent J-L et al, 1995


:

  • (, )


    • -

    • CASCAT - - -

    • - (+) : S. aureus Enterococcusspp.

    • NPRS - (-) .

    • -


    ( 2006 )

    • Enterobacteriaceae 32,0%

    • P. aeruginosa 27,3%

    • Staphylococcus spp. 18,8%

    • Acinetobacter baumannii 10,4%

    • Enterococcus spp. 5,7%

    • Stenotrophomonas maltophilia 1,5%

      4,3%


    1996

    P. aeruginosa

    E.coli

    Klebsiella

    P.mirabilis

    Enterobacter

    Acinetobacter baumannii

    2006

    P. aeruginosa

    Acinetobacter

    Klebsiella

    E.coli

    Enterobacter

    Stenotrophomonas maltophilia

    Burkholderia cepacia

    (-)


    ()

    17 , 15 , n=136, 2003 2006

    Enterobacteriaceae: E.coli, Klebsiella, Proteus, Enterobacter


    -

    I II III IV

    +++--

    • +----

    • ++++-

    • NmcA, Sme, Imi----+

      D++++-

      +++++


    (MYSTIC)

    Turner PJ. 13th ECCMID. Clin Microb Infect 2003; 9 (6)


    Enterobacteriaceae

    33 ( 2002 -2004)


    Enterobacteriaceae

    33 ( 2002 -2004)


    (Klebsiella spp., E.coli, P.mirabilis)

    • :

      • Klebsiella spp. E.coli

      • in vitro III

      • : Klebsiellapneumoniae

        R

        / R

        S

        S 1-

        R

        S

        /S

        R

        R

        R

        R

        + /S 2-


    -

    • ,

      Pseudomonas spp.,

      Enterobacteriaceae


    P. aeruginosa

    33 ( 2002 -2004)


    (-) ( 2006 )

    • P. aeruginosa 27,3 %

    • Acinetobacter 10,4%

    • Stenotrophomonas maltophilia 1,5%

    • 5,7%


    P. Aeruginosa 33 ( 2002 -2004)

    73,1%

    7,8% , 28%-

    ,


    Acinetobacter

    33 ( 2002 -2004)


    (-)

    • Burkholderia cepacia .

      • , , , -, .

      • : , .

  • Stenotrophomonas maltophilia : -

    • :

      • /,

        , /, .

      • .

    • : .


  • R

    R

    SR

    S R

    R

    S R

    S

    S

    Methicillin (Oxacillin)

    Resistant

    Staphylococcus

    Aureus

    • : -

    • MRSA


    RSA

    1995 1996 0 40% 9.5%

    [.. ]

    2000 20010 89.5%33.5%

    [.. ]

    2004 64.9%

    [ ]

    41%

    63%


    MSSA

    /

    MRSA

    ()

    -

    • MSSA MSSA-

      • 0/10

      • 8/17 (47%)

    • Gonzalez C. e.a.CID 1999;


    - (VRE)

    , -27.5%

    3,8%

    2002 ,

    250

    VRE

    /, /


    : ?

    • (VISA)

    • -

    • ,



      • -

      • ()

    • , .



    ()

    • 2004 .

    • 2005 .

    • 2005 .

    • 2006 .


    !


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