乐山地区多重耐药菌感染的临床分析与耐药性监测

Clinical analysis and drug resistance monitoring of multidrug-resistant organism infection in Leshan region

目的探讨乐山地区多重耐药菌(multidrug-resistant organism,MDRO)感染情况与耐药性。方法选择2017年1月—2018年12月在乐山市3家三甲医院住院患者送检的各类标本分离出的耐药菌为研究对象,进行细菌鉴定和药敏试验,分析MDRO的来源、临床分布和耐药性特征。结果2017年1月—2018年12月乐山市3家三甲医院共分离出非重复菌株13287株,其中MDRO3257株(占24.51%),MDRO主要为产超广谱β内酰胺酶(extended-spectrumβ-lactamases,ESBLs)大肠埃希菌、产ESBLs肺炎克雷伯菌和多重耐药鲍曼不动杆菌(multi-drug resistance Acinetobacter baumannii,MDR-AB),MDRO标本主要来源为痰标本(44.67%)和尿液(19.25%);MDRO标本主要临床来源为重症监护室(intensive care unit,ICU)(19.19%),其次为新生儿科(15.23%)和神经外科(14.15%)。产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌对美罗培南和亚胺培南敏感,MDR-AB对氨苄西林/舒巴坦敏感,多重耐药/泛耐药铜绿假单胞菌(MDR-PA/PDR-PA)仅对左氧氟沙星敏感,耐碳青霉烯肺炎克雷伯菌对替加霉素敏感,耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)对万古霉素、替加霉素敏感。结论乐山地区多重耐药菌以产ESBLs大肠埃希菌最多,其次为产ESBLs肺炎克雷伯菌和MDR-AB,临床治疗时应结合MDRO药敏结果合理使用抗菌药,严格掌握药物指征,同时积极采取预防措施,减少医院感染暴发流行。

Objective To investigate the infection status and drug resistance of multidrug-resistant organism(MDRO)in Leshan region.Methods Drug-resistant bacteria isolated from all kinds of specimens from patients in three tertiary grade A hospitals in Leshan city from January 2017 to December 2018 were selected as the research subjects.Bacterial identification and drug sensitivity test were conducted,and the source,clinical distribution and drug resistance characteristics of MDRO were analyzed.Results A total of 13,287 non-repetitive strains were isolated from three tertiary grade A hospitals in Leshan city from January 2017 to December 2018,including 3,257 strains of MDRO(accounting for 24.51%).The detected strains of MDRO were mainly extended-spectrumβ-lactamases(ESBLs)-producing Escherichia coli,ESBLs-producing Klebsilla pneunmoniae and multi-drug resistance Acinetobacter baumannii(MDR-Ab).The main sources of MDRO specimens were sputum(44.67%)and urine(19.25%).The clinical source of MDRO specimens was mainly from intensive care unit(19.19%),followed by neonatology department(15.23%)and neurosurgery department(14.15%).ESBLs-producing Escherichia coli and ESBLs-producing Klebsilla pneunmoniae were sensitive to meropenem and imipenem,MDR-AB to ampicillin/sulbactam,multi-drug resistant/pan-drug resistant Pseudomonas aeruginosa(MDR-PA/PDR-PA)only to levofloxacin,carbapenem-resistant Klebsiella pneumonia to tigecycline,and methicillin-resistant Staphylococcus aureus(MRSA)to vancomycin and tigecyclin.Conclusions ESBLs-producing Escherichia coli is the most common multidrug-resistant bacterium in Leshan region,followed by ESBLs-producing Klebsilla pneunmoniae and MDR-AB.As for clinical treatment,antibiotics should be reasonably used in combination with drug sensitivity results of MDRO,drug indications should be strictly controlled,and preventive measures should be taken simultaneously and actively so as reduce the outbreak of nosocomial infection.