2017年至2021年上海嘉定区某医院多重耐药菌分析

Clinical isolates of multi drug resistant bacteria in a hospital from 2017 to 2021 in Jiading District of Shanghai

目的:分析本地区近5年临床多重耐药菌的检出率和变化趋势以及碳青霉烯类耐药革兰阴性杆菌的耐药特征,为院内感染防控和抗菌药物经验治疗提供实验室依据。方法:回顾性分析2017年1月至2021年12月住院患者临床标本分离的7种多重耐药菌的检出率,包括甲氧西林耐药金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)、万古霉素耐药肠球菌属细菌(vancomycin resistant Enterococcus,VRE)、产超广谱β-内酰胺酶大肠埃希菌(extended spectrum β-lactamases producing Escherichia coli,ESBL-eco)、产超广谱β-内酰胺酶肺炎克雷伯菌(extended spectrum β-lactamases producing Klebsiella pneumoniae,ESBL-kpn)、碳青霉烯类耐药肠杆菌目细菌(carbapenem resistant Enterobacteriaceae,CRE)、碳青霉烯类耐药鲍曼不动杆菌(carbapenem resistant Acinetobacter baumannii,CR-AB)和碳青霉烯类耐药铜绿假单胞菌(carbapenem resistant Pseudomonas aeruginosa,CR-PA),并分析碳青霉烯类耐药革兰阴性杆菌对常用抗菌药物的耐药率和CRE菌株的产碳青霉烯酶情况。结果:本研究未检出VRE,除ESBL-eco外,其余5种多重耐药菌检出率在5年间呈上升趋势,MRSA、ESBL-kpn、CRE、CR-AB和CR-PA检出率分别波动在37.0%~53.6%、19.3%~34.3%、2.5%~10.6%、34.1%~63.4%和11.3%~22.8%;全院的CRE、CR-AB和CR-PA分离株中分别有65.4%、72.0%和59.3%分离自ICU。CRE和CR-AB对喹诺酮类、头孢类和β内酰胺酶抑制剂复合制剂等临床常用抗菌药物耐药率达90.0%;272株CRE中,肺炎克雷伯菌221株,占81.3%,对其中90株CRE菌株进行碳青霉烯酶检测,检出产KPC、NDM和IMP3种碳青霉烯酶,其中KPC酶构成比为90.0%。结论:本研究6种多重耐药菌的检出率大多低于同期上海市和全国三级医院平均水平,但MRSA、ESBL-kpn、CRE、CR-AB和CR-PA呈上升趋势,应引起重视,尤其应关注ICU病区碳青霉烯类耐药革兰阴性杆菌耐药株。本研究检出CRE产3种碳青霉烯酶,其中90.0%为KPC酶。

Objective:To analyze detection rate and changing trend of clinical multi-drug resistant bacteria(MDRB)in recent 5 years,and explore drug resistance characteristics of carbapenem resistant gram-negative bacteria,so as to provide reference for nosocomial infection prevention and control and empirical treatment of antibiotics in clinical practice.Methods:Seven kinds of MDRB isolated from clinical specimens of hospitalized patients during January 2017 to December 2021 were retrospectively analyzed,including methicillin-resistant Staphylococcus aureus(MRSA),vancomycin resistant Enterococcus(VRE),extended spectrum β-lactamases producing Escherichia coli(ESBL-eco),extended spectrum β-lactamases producing Klebsiella pneumoniae(ESBL-kpn),carbapenem resistant Enterobacteriaceae(CRE),carbapenem resistant Acinetobacter baumannii(CR-AB)and carbapenem resistant Pseudomonas aeruginosa(CR-PA).The rate of carbapenem resistant gram-negative bacilli to common antibiotics and the carbapenemase production of CRE strain were analyzed with SPSS 20.0.Results:VRE was not detected in this study.Except ESBL-eco,the isolated rates of the other five MDRB increased in the past five years.The detection rates of MRSA,ESBL-kpn,CRE,CR-AB and CR-PA fluctuated between 37.0%-53.6%,19.3%-34.3%,2.5%-10.6%,34.1%-63.4%and 11.3%-22.8%,respectively.It revealed that 65.4%CRE,72.0%CR-AB,and 59.3%CR-PA isolates were isolated from ICU.The resistant rates of CRE and CR-AB to quinolones,cephalosporins andβ-Lactamase inhibitor complex were 90.0%.Among 272 CRE strains,221 strains were Klebsiella pneumoniae,accounting for 81.3%.The carbapenemase was detected in 90 strains of CRE,in which three kinds of carbapenemases(KPC,NDM and IMP)were detected and the constituent ratio of KPC enzyme was 90.0%.Conclusions:The isolated rates of six MDRB in this study are much lower than the average level in Shanghai and national tertiary hospitals in the same period,but the isolated rates of MRSA,ESBL-kpn,CRE,CR-AB and CR-PA show an upward trend,which should be paid attention to,especially the carbapenem resistant gram-negative bacteria in ICU.In this study,90 strains of CRE tested produced three kinds of carbapenem enzymes,in which KPC enzymes showed a high proportion.