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Objective To investigate the clinical features and risk factors of multidrug－resistant bacteria (multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012－2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23% . ESBLs, CR－AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time ＞20 d, level of consciousness (coma), occupancy of ICU ≥7 d, ventilation (invasive), number of antibiotics used≥3, combined use of antibiotics≥3, mechanical ventilation Time≥7 d were possible risk factors for MDROs infection in neurosurgical patients (P＜0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad－spectrum antibiotics, reduce unnecessary mechanical ventilation time, change to non－invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.
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OBJECTIVE:To provide reference for rational drug use and hospital infection control. METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan. 2011-Oct. 2017. Drug sensitivity test was conducted by using MIC. The situation of AmpC enzyme production was confirmed by three dimensional test, and that of ESBLs-producing stain was detected with double-disk synergy test. RESULTS:There were 546 strains of AmpC enzyme-producing E. cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80% of non-sputum specimen (546/11 375)and 38.97% of E. cloacae(546/1 401). Top 3 non-sputum samples in the list of detection rate were wound secretion (27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%), neurosurgery department(18.68%)and general surgery department(16.67%). Resistance rate of AmpC enzyme-producing E. cloacae to most commonly used antibiotics was higher than 40%. There was statistical significance in resistant rate of the bacteria to ceftriaxone, cefotaxime, gentamicin, nitrofurantoin, levofloxacin, piperacillin/tazobactam, cefoperazone, ceftazidime,cefepime,tobramycin and minocycline among different years (P<0.05). The resistant rate to imipenem and meropenem was lower than 2%. Among 546 strains of AmpC enzyme-producing E. cloacae,68 strains of ESBLs were detected,and detection rates were 5.77%,6.06%,8.70%,10.26%,13.79%,17.35%,18.75% during 2011-2017. CONCLUSIONS:AmpC enzyme-producing E. cloacae are mainly isolated from samples as wound secretion and midstream urine,and mainly come from ICU and neurosurgery department. The drug resistance of the bacteria is severe,and drug resistance of the bacteria to antibiotics as β-lactams and quinolones is increased significantly. The detection rate of ESBLs-producing strain increases year by year. The bacteria are sensitive to carbapenems antibiotics,which can be regarded as first choice. It is necessary to strengthen drug resistance and enzyme production monitoring of AmpC enzyme-producing E. cloacae,select antibiotics combined with results of drug sensitivity test so as to prevent or delay the rapid increase of its resistance rate.