¹ Монгол Улсын Нэгдүгээр төв эмнэлгийн Яаралтай тусламж сургалт арга зүйн төв

² Говьсүмбэр аймгийн нэгдсэн эмнэлэг

Үжилтэй өвчтөнийг амжилттай эмчлэх явдал нь дэлхий дахины анагаах ухаанд анхаарал татсан асуудал байсаар ирсэн бөгөөд бүс нутгийн онцлог, анагаах ухааны хөгжлийн түвшин зэргээс хамаарч үр дүн нь улс орон бүрт харилцан адилгүй байдаг билээ.1 Үүсгэж буй нянгийн төрлөөс үл хамааран эрт, оновчтой антибиотик эмчилгээ эхлэх нь үжилтэй өвчтөний амь аврагдахад шийдвэрлэх үүрэгтэй.2 Нян антибиотикт тэсвэржих нь таамаг болон нотолгоот антибиотик эмчилгээний оновчтой байдалд онцгой нөлөөтэй.2 Нянгийн тэсвэржилт нь улс орон бүрт харилцан адилгүй байдаг ба антибиотикийн борлуулалт болон хэрэглээ хяналтгүй, хөрөнгө санхүүгийн байдлаас хамааран хязгаарлагдмал, цөөн нэр төрлийн антибиотик хэрэглэдэг зэрэгтэй холбоотойгоор хөгжиж буй орнуудад харьцангуй өндөр байдаг.3-4

Currently, the reported mortality rate of severe sepsis and septic shock ranged 64.3%-86.4% at the ICU of National Central Hospital and majority of these cases were caused by multiple resistant bacteria (MRB). Antibiotic resistance is an important factor influencing the adequacy of both empirical and targeted antibiotic therapy in sepsis. Methods: This analysis was designed as a prospective observational study. During the time from january of 2011 to august of 2012, it was conducted in a nine bed multidisciplinary intensive care unit of a tertiary teaching hospital in Ulaanbaatar, the capital city of Mongolia. The ICU treatment outcome and length of stay were compared between the patient groups which infected by resistant and non resistant bacteria. Results: Extensively resistant bacteria were observed in 22% and multidrug-resistant bacteria in 25.1% of microbiological cultures. In total, 51.6% of the study patients were infected by one or more resistant bacteria. Bacteria with an exceptionally high rate of antibiotic resistance (≥60%) were Acinetobacter baumannii, Enterobacter spp and coagulase-negative Staphylococci. Sepsis patients infected with resistant bacteria received more mechanical ventilation, renal replacement\ therapy more frequently and suffered from multiple organ dysfunction more often than sepsis patients without resistant bacteria. The length of stay in the intensive care unit was longer in sepsis patients with resistant bacteria but the mortality rate in the intensive care unit did not significantly differ between groups despite a trend towards a higher fatality rate in sepsis patients infected with resistant bacteria. The adequacy of empiric antibacterial therapy  were measured as matched in 38% and missed in 33.9% and in 27.9% were not assessed. In conclusion, resistant bacteria were detected in up to 50% of microbiological samples from critically ill sepsis patients in the intensive care unit of tertiary teaching hospital Mongolia. Antibiotic resistance appears to be a relevant problem of sepsis management in a Mongolian intensive care unit setting.

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